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Ugolini A, Abate A, Donelli M, Gaffuri F, Bruni A, Maspero C, Lanteri V. Spontaneous Mandibular Dentoalveolar Changes after Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander-A Systematic Review. Children (Basel) 2024; 11:501. [PMID: 38671718 PMCID: PMC11049362 DOI: 10.3390/children11040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander. METHODS The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed. RESULTS A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated. CONCLUSIONS SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.
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Affiliation(s)
- Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Margherita Donelli
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Francesca Gaffuri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Valentina Lanteri
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
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Vichare S, Vichare G. Treatment of maxillary hypoplasia with bone anchored maxillary protraction (BAMP) - A case report. J Orthod Sci 2024; 13:12. [PMID: 38516114 PMCID: PMC10953726 DOI: 10.4103/jos.jos_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/30/2023] [Accepted: 09/13/2023] [Indexed: 03/23/2024] Open
Abstract
Early diagnosis and treatment is known to be beneficial in Class III malocclusions secondary to maxillary hypoplasia. However, success of treatment largely depends on the patient's compliance and thus, appropriate choice of treatment, appliance and the age for interception plays an important role. Bone anchored maxillary protraction is one such approach presented in this case report for a 13 years old boy who reported with the chief complaint of lower front teeth visibility during speech and smiling. On examination his molars were in Angle's Class III relation, anterior crossbite and deep bite with unerupted maxillary canines. Orthodontic treatment was begun for deep bite correction and for creating space for the maxillary canines, followed by surgical intervention for placement of bone anchored miniplates. Protraction was done for 14 months and the total treatment time was 20 months. Improvement in the patient's profile, aesthetics and function was achieved with well aligned arches.
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Affiliation(s)
- Sharvari Vichare
- Department of Orthodontics and Dentofacial Orthopedics, Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS) Bathinda, Punjab, India
| | - Gauri Vichare
- Department of Orthodontics and Dentofacial Orthopedics, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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Nelke K, Diakowska D, Morawska-Kochman M, Janeczek M, Pasicka E, Łukaszewski M, Żak K, Nienartowicz J, Dobrzyński M. The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses-A Proposal of Classification. J Pers Med 2023; 13:1258. [PMID: 37623508 PMCID: PMC10455419 DOI: 10.3390/jpm13081258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients.
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Affiliation(s)
- Kamil Nelke
- Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wrocław, Poland
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Dorota Diakowska
- Department of Basic Sciences, Wroclaw Medical University, Chalubinskiego 3, 50-368 Wroclaw, Poland;
| | - Monika Morawska-Kochman
- Department of Head and Neck Surgery, Otolaryngology Medical University in Wrocław, Borowska 213, 50-556 Wrocław, Poland;
| | - Maciej Janeczek
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland;
| | - Edyta Pasicka
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland;
| | - Marceli Łukaszewski
- Department of Anaesthesiology and Intensive Care, Sokołowski Hospital, Sokołowskiego 4, 58-309 Wałbrzych, Poland;
| | - Krzysztof Żak
- Academy of Applied Sciences, Health Department, Academy of Silesius in Wałbrzych, Zamkowa 4, 58-300 Wałbrzych, Poland;
| | - Jan Nienartowicz
- Private Practise of Maxillo-Facial Surgery, Romualda Mielczarskiego 1, 51-663 Wrocław, Poland;
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland;
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Knoedler S, Baecher H, Hoch CC, Obed D, Matar DY, Rendenbach C, Kim BS, Harhaus L, Kauke-Navarro M, Hundeshagen G, Knoedler L, Orgill DP, Panayi AC. Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database. J Clin Med 2023; 12. [PMID: 36835979 DOI: 10.3390/jcm12041444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. RESULTS The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). CONCLUSION Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.
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Kim EN, Moss WD, Rosales MN, Lyon N, Lotz A, Yamashiro DK, Gociman BR, Siddiqi FA, Johns DN. Multidisciplinary Presurgical Education: Clinical Impact on Children With Orofacial Clefts Undergoing Maxillary Distraction via Rigid External Distraction. Cleft Palate Craniofac J 2023; 60:75-81. [PMID: 34730019 DOI: 10.1177/10556656211055411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation. DESIGN From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES. RESULTS MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32). CONCLUSIONS Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.
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Affiliation(s)
- Erinn N Kim
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Whitney D Moss
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Megan N Rosales
- Biostatistician. University of Utah Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Natalee Lyon
- RN Cleft Care Coordinator, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Analise Lotz
- Certified Child Life Specialist, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Duane K Yamashiro
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital and 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Barbu R Gociman
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Faizi A Siddiqi
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Dana N Johns
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
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Yuan Z, He S, Jiang T, Xie Q, Zhou N, Huang X. Augmented reality hologram combined with pre-bent distractor enhanced the accuracy of distraction vector transfer in maxillary distraction osteogenesis, a study based on 3D printed phantoms. Front Surg 2022; 9:1018030. [PMID: 36468075 PMCID: PMC9709275 DOI: 10.3389/fsurg.2022.1018030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Vector control is a significant concern in maxillary distraction osteogenesis (DO). Distraction vector planning on the patient's 3D-printed skull phantom is more intuitive for surgeons and cost-efficient than virtual surgical planning. However, the accuracy of transferring the planned vector to intraoperative (vector transfer) according to the shape of the pre-bent footplate alone is relatively limited. The application of augmented reality (AR) in surgical navigation has been studied for years. However, few studies have focused on its role in maxillary DO vector transfer. This study aimed to evaluate the accuracy of AR surgical navigation combined with the pre-bent distractor in vector transfer by comparing it with the pre-bent distractor alone. METHODS Ten patients with maxillary hypoplasia were enrolled with consent, and three identical 3D-printed skull phantoms were manufactured based on per patient's corresponding pre-operative CT data. Among these, one phantom was for pre-operative planning (n = 10), while and the other two were for the AR+Pre-bending group (n = 10) and the Pre-bending group (n = 10) for the experimental surgery, respectively. In the Pre-bending group, the distraction vector was solely determined by matching the shape of footplates and maxillary surface. In the AR+Pre-bending group, the distractors were first confirmed to have no deformation. Then AR surgical navigation was applied to check and adjust the vector in addition to the steps as in the Pre-bending Group. RESULTS For the angular deviation of the distraction vector, the AR+Pre-bending group was significantly smaller than the Pre-bending group in spatial (p < 0.001), x-y plane (p = 0.002), and y-z plane (p < 0.001), and there were no significant differences in the x-z plane (p = 0.221). The AR+Pre-bending group was more accurate in deviations of the Euclidean distance (p = 0.004) and the y-axis (p = 0.011). In addition, the AR+Pre-bending group was more accurate for the distraction result. CONCLUSIONS In this study based on 3D printed skull phantoms, the AR surgical navigation combined with the pre-bent distractor enhanced the accuracy of vector transfer in maxillary DO, compared with the pre-bending technique alone.
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Affiliation(s)
- Zongyi Yuan
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Shixi He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Tianhua Jiang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Qingtiao Xie
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Xuanping Huang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
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Shenoy RD, Shetty V, Dheedene A, Menten B, Pandyanda Nanjappa D, Chakraborty G, Sips P, de Paepe A, Callewaert B, Chakraborty A. Phenotypic and Molecular Heterogeneity in Mandibulofacial Dysostoses: A Case Series From India. Cleft Palate Craniofac J 2021; 59:1346-1351. [PMID: 34714179 DOI: 10.1177/10556656211050006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Facial dysostosis is a group of rare craniofacial congenital disabilities requiring multidisciplinary long-term care. This report presents the phenotypic and genotypic information from South India. DESIGN The study is a case series. SETTING This was an international collaborative study involving a tertiary craniofacial clinic and medical genetics unit. PATIENTS, PARTICIPANTS The participants were 9 families with 17 affected individuals of facial dysostosis. INTERVENTION Exome analysis focused on known genes associated with acrofacial and mandibulofacial syndromes. MAIN OUTCOME MEASURE The outcome measure was to report phenotyptic and genetic heterogeneity in affected individuals. RESULTS A Tessier cleft was seen in 7 (41%), lower eyelid coloboma in 12 (65%), ear anomalies in 10 (59%), uniolateral or bilateral aural atresia in 4 (24%), and deafness in 6 (35%). The facial gestalt of Treacher Collins syndrome (TCS) showed extensive phenotypic variations. Pathogenic variants in TCOF1 (Treacher Collins syndrome) were seen in six families, POLR1A (acrofacial dysostosis, Cincinnati type) and EFTUD2 (mandibulofacial dysostosis with microcephaly) in one each. One family (11.1%) had no detectable variation. Five out of six probands with Treacher Collins syndrome had other affected family members (83.3%), including a non-penetrant mother, identified after sequencing. CONCLUSION Our report illustrates the molecular heterogeneity of mandibulofacial dysostosis in India.
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Affiliation(s)
- Rathika D Shenoy
- Department of Pediatrics, KS Hegde Medical Academy, 231912Nitte (Deemed to be University), Mangaluru, India
| | - Vikram Shetty
- Department of Maxillofacial Surgery, AB Shetty Memorial Institute of Dental Sciences, Nitte Meenakshi Institute of Craniofacial Surgery, 231912Nitte (Deemed to be University), Mangaluru, India
| | - Annelies Dheedene
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University Hospital, 26656Ghent University, Ghent, Belgium
| | - Björn Menten
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University Hospital, 26656Ghent University, Ghent, Belgium
| | - Dechamma Pandyanda Nanjappa
- Division of Molecular Genetics and Cancer, Nitte University Centre for Science Education and Research (NUCSER), 231912Nitte (Deemed to be University), Mangaluru, India
| | - Gunimala Chakraborty
- Division of Molecular Genetics and Cancer, Nitte University Centre for Science Education and Research (NUCSER), 231912Nitte (Deemed to be University), Mangaluru, India
| | - Patrick Sips
- Department of Biomolecular Medicine, 26656Ghent University, Ghent, Belgium
| | - Anne de Paepe
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University Hospital, 26656Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University Hospital, 26656Ghent University, Ghent, Belgium
| | - Anirban Chakraborty
- Division of Molecular Genetics and Cancer, Nitte University Centre for Science Education and Research (NUCSER), 231912Nitte (Deemed to be University), Mangaluru, India
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Rubio-Palau J, Ayats-Soler M, Albert-Cazalla A, Martìnez-Padilla I, Prieto-Gundin A, Prieto-Peronnet N, Ramìrez-Fernández MP, Mareque-Bueno J. Accuracy of Virtually Planned Maxillary Distraction in Cleft Patients - An Evaluative Study. Ann Maxillofac Surg 2021; 11:49-57. [PMID: 34522654 PMCID: PMC8407633 DOI: 10.4103/ams.ams_331_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/07/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Maxillary distraction may be used to treat severe maxillary hypoplasia in cleft lip and palate (CLP) patients. Three-dimensional (3D) planning has been shown to increase the accuracy of distraction and reduce operative time and complications. The aim of the study was to measure the accuracy of internal maxillary distraction after 3D planning in CLP patients, to add evidence to validate the virtual osteotomy and distraction procedure. Materials and Methods: Eleven CLP patients with severe maxillary hypoplasia underwent maxillary distraction using internal distractors. Virtual planning was used to design the osteotomies, the distractor position, and the distraction vector. Cutting and positioning guides transferred this information to the surgical procedure. Four to six month postoperative computed tomography-scan was done before distractor removal; anatomical reference points were compared to the virtual planning to determine accuracy. Results: A high accuracy (point dislocation <1.5 mm) was found in 90% of the points of the surface of the maxilla; the majority of the zygomatic screws were placed within a distance of 0.8–1 mm from their planned position. Discussion: The high accuracy achieved through virtual planning promotes optimal distractor placement; a customized distraction vector has a direct effect on the final position of the maxilla.
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Affiliation(s)
- Josep Rubio-Palau
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain.,Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | - Marta Ayats-Soler
- Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | | | - Irene Martìnez-Padilla
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain
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Siddiqui HP, Sennimalai K, Samrit VD, Duggal R, Yadav R. Adjunctive orthodontic therapy for prosthetic rehabilitation in a growing child with Axenfeld-Rieger syndrome: A case report. Spec Care Dentist 2021; 41:423-430. [PMID: 33719126 DOI: 10.1111/scd.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
AIM The congenital oligodontia impeding the development of the alveolar process resulting in disproportionate jaw growth has been previously reported. This case report describes the interdisciplinary management of an 11-year-old girl with Axenfeld-Rieger syndrome exhibiting oligodontia and maxillary hypoplasia. METHODS AND RESULTS An adjunctive orthodontic therapy was performed by taking advantage of bone-anchored maxillary protraction (BAMP) therapy using miniplates and 24-hour traction by intermaxillary Class III elastics. After 6 months of active treatment, the maxilla advanced by approximately 5 mm and upper lip relation improved by 3 mm without any significant changes in vertical relations. All the changes were maintained at 15th-month follow-up. A temporary removable prosthesis was given for immediate esthetics, and the definitive management is discussed. CONCLUSION The BAMP therapy can be a befitting alternative in cases exhibiting complex presentation involving skeletal and dentoalveolar components. An appreciable profile improvement without any dentoalveolar side effects can be achieved with BAMP therapy.
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Affiliation(s)
- Hamza Parvez Siddiqui
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Sennimalai
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vilas D Samrit
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Division of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Abate A, Cavagnetto D, Rusconi FME, Cressoni P, Esposito L. Safety and Effects of the Rapid Maxillary Expander on Temporomandibular Joint in Subjects Affected by Juvenile Idiopathic Arthritis: A Retrospective Study. Children (Basel) 2021; 8:33. [PMID: 33430404 PMCID: PMC7827492 DOI: 10.3390/children8010033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Juvenile Idiopathic Arthritis (JIA) temporo-mandibular joints are often affected causing skeletal and dental malocclusions. The most frequent condition is mandibular hypoplasia, that may be associated with maxillary hypoplasia. The aim of this retrospective case control study is to investigate the effects and the safety of rapid maxillary expansion (RME) in growing patients affected by JIA. It was evaluated whether RME could be performed without complications on TMJs of JIA patients using DC/TMD protocol, and naso-maxillary transversal parameters were compared with the ones obtained on healthy patients. METHODS Twenty-five patients affected by JIA that ceased to manifest TMJ (Temporo-Mandibular Joint) symptoms in the previous year were treated with RME to solve the maxillary transverse hypoplasia. Postero-anterior cephalometric tracings were collected before and after treatment; linear measurements were obtained to study maxillary and nasal cavity modifications. Data were compared to those of a similar group of twenty-five healthy patients. Paired t-test and Independent t-test were used to evaluate changes before and after treatment in each group and to perform a comparison between the groups. RESULTS All patients demonstrated a statistically significant increase in nasal cavity width, maxillary width and upper and lower intermolar width. No patients presented a worsening of their TMJs condition. Intragroup comparisons revealed significant changes of cephalometric measurements, but no difference was found when comparing JIA and healthy patients. CONCLUSIONS Growing patients with JIA that ceased to show signs of active TMJ involvement for at least one year could be safely treated with RME, expecting similar benefits to those of healthy patients. Dentists and rheumatologists should be informed of safety and potential benefits of palatal expansion in JIA patients in order to improve the outcome of orthodontic treatment and reduce the indication for more invasive procedures (i.e., Surgical Assisted Rapid Maxillary Expansion).
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Affiliation(s)
- Andrea Abate
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Davide Cavagnetto
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Francesca Maria Emilia Rusconi
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Luca Esposito
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
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Zhang Z, Zhang P, Li S, Cheng J, Yuan H, Jiang H. Skeletal, dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate. Int J Oral Maxillofac Surg 2020; 50:774-781. [PMID: 33054994 DOI: 10.1016/j.ijom.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/09/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Maxillary skeletal deficiency secondary to cleft lip and palate (CLP) remains a significant challenge. The aim of this study was to present the comprehensive skeletal, dental and facial aesthetic outcomes of anterior maxillary segmental distraction osteogenesis (AMSDO) for treatment of maxillary hypoplasia in patients with CLP. Twelve patients with maxillary hypoplasia treated with AMSDO by a customized tooth-borne distractor were included. Three-dimensional changes of anterior maxillary segment, upper incisor and pharyngeal space were measured by three-dimensional reconstruction derived from cone beam computed tomography (CBCT) data. Length and width of dental arch during distraction were determined in dental casts. Nasolabial angle, soft-tissue convexity and patient's subjective satisfaction were assessed to evaluate facial aesthetic improvements. Nasopharyngoscopic evaluation and speech assessment were also performed before and after distraction. All patients successfully received AMSDO without serious complications. Following AMSDO, the anterior maxillary segments moved forward 5.56±0.28mm and slightly upward 1.15±0.13mm. AMSDO significantly lengthened maxillary dental arch, generated new bone to relieve dental crowding and improved patients' facial aesthetic without worsening velopharyngeal closure and speech quality. AMSDO by tooth-borne distractor is an effective surgical alternative for the advancement in patients with cleft maxillary hypoplasia.
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Affiliation(s)
- Z Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu Province, China; Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - P Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - S Li
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - J Cheng
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - H Yuan
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - H Jiang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, Jiangsu Province, China; Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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12
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Rachmiel A, Turgeman S, Shilo D, Aizenbud D, Emodi O. Skeletal stability in patients with clefts after large maxillary advancements using intraoral distraction. Br J Oral Maxillofac Surg 2020; 58:663-8. [PMID: 32439215 DOI: 10.1016/j.bjoms.2020.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/25/2020] [Indexed: 11/22/2022]
Abstract
Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after surgical and orthodontic interventions, and maxillary distraction osteogenesis has become a useful procedure for patients with extensive maxillary deformities. The aim of this study was to evaluate long term (two years) stability after maxillary advancement of more than 10mm by distraction osteogenesis in cleft patients using internal devices. We organised a retrospective study on 42 patients with cleft lip and palate using cephalometric analysis before and after maxillary distraction osteogenesis and evaluated them for 24 months. Postoperative measurements showed a marked advancement with an increase of 13.3mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including a shift from Angle class III to class I in dental relations. Follow-up observations showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8 (0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively and a negligible regression at the two years' follow up. This large-scale study shows stable results of skeletal advancement using distraction osteogenesis, indicating safe and reliable outcomes among patients with cleft lip and palate.
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13
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Langeveld M, Bruun RA, Koudstaal MJ, Padwa BL. Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity. Cleft Palate Craniofac J 2019; 56:1333-1339. [PMID: 31610716 DOI: 10.1177/1055665619853373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement. DESIGN Retrospective case-control study. SETTING Tertiary care center. PATIENTS/PARTICIPANTS Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years). MAIN OUTCOME MEASURES Lower lip thickness and eversion. RESULTS Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip (P = .019) and outward rotation of the vermilion border (P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP (P = .035). Lower lip thickness and rotation did not change after maxillary advancement. CONCLUSIONS Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.
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Affiliation(s)
- Mirte Langeveld
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Richard A Bruun
- Department of Developmental Biology, Harvard, School of Dental Medicine, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Maarten J Koudstaal
- Erasmus University Medical Center, Rotterdam, the Netherlands.,Head of Craniofacial Malformations, Karolinska Institute, Stockholm, Sweden
| | - Bonnie L Padwa
- Harvard School of Dental Medicine and Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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14
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Williams R, Patel V, Chen YF, Tangbumrungtham N, Thamboo A, Most SP, Nayak JV, Liu SYC. The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction. Otolaryngol Head Neck Surg 2019; 161:171-177. [PMID: 30909809 DOI: 10.1177/0194599819838262] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery. STUDY DESIGN Retrospective case-control study. SETTING Tertiary academic center. METHODS Institutional review board-approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate. RESULTS Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle (P = .035), narrow maxillary width (P = .006), and high arched palate (P = .004). CONCLUSION Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.
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Affiliation(s)
- Ryan Williams
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Vishal Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,2 Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Yu-Feng Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,3 Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Navarat Tangbumrungtham
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,4 Department of Otorhinolaryngology, Ramathibodi Hospital, Bangkok, Thailand
| | - Andrew Thamboo
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,5 Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Sam P Most
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jayakar V Nayak
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Stanley Y C Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Menéndez‐Díaz I, Muriel J, Cobo JL, Álvarez C, Cobo T. Early treatment of Class III malocclusion with facemask therapy. Clin Exp Dent Res 2018; 4:279-283. [PMID: 30603110 PMCID: PMC6305966 DOI: 10.1002/cre2.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/13/2022] Open
Abstract
The facemask is a widely used device in the treatment of Class III malocclusion and is intended to anteriorly displace the superior maxilla or stimulate its growth in that direction. The main goal of this study was to evaluate the effects of treatment using orthopedic maxillary expansion with facemask therapy in patients with Class III malocclusion. Sixty-four patients, with a mean age of 8.14 ± 1.18 years at the start of treatment and a mean age of 9.78 ± 1.19 years at the end, were treated using orthopedic maxillary expansion and associated facemask therapy. The patients were evaluated using lateral head teleradiography before and after treatment, and the differences were analyzed. In addition, binary logistic regression was used as a model for predicting successful treatment. When comparing the changes achieved by treatment, statistically significant favorable changes were found at the skeletal level. Furthermore, an improvement in the airways at all levels was detected. Orthopedic maxillary expansion associated with facemask therapy has proven effective in treating early skeletal Class III malocclusion.
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Affiliation(s)
- Iván Menéndez‐Díaz
- Surgery and Medical‐Surgical SpecialtiesUniversidad de OviedoSpain
- Orthodontics Division, Instituto Asturiano de OdontologiaUniversidad de OviedoSpain
| | - Juan Muriel
- Diagnostic Imaging Division, Instituto Asturiano de OdontologiaUniversidad de OviedoSpain
| | - Juan L. Cobo
- Maxillofacial Surgery ServiceHospital Universitario Central de AsturiasSpain
| | - Covadonga Álvarez
- Surgery and Medical‐Surgical SpecialtiesUniversidad de OviedoSpain
- Orthodontics Division, Instituto Asturiano de OdontologiaUniversidad de OviedoSpain
| | - Teresa Cobo
- Surgery and Medical‐Surgical SpecialtiesUniversidad de OviedoSpain
- Orthodontics Division, Instituto Asturiano de OdontologiaUniversidad de OviedoSpain
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16
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Kakutani H, Sato Y, Tsukamoto-Takakusagi Y, Saito F, Oyama A, Iida J. Evaluation of the maxillofacial morphological characteristics of Apert syndrome infants. Congenit Anom (Kyoto) 2017; 57:15-23. [PMID: 27534905 DOI: 10.1111/cga.12180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/29/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022]
Abstract
Apert syndrome is a rare craniosynostosis syndrome characterized by irregular craniosynostosis, midface hypoplasia, and syndactyly of the hands and feet. Previous studies analyzed individuals with Apert syndrome and reported some facial and intraoral features caused by severe maxillary hypoplasia. However, these studies were performed by analyzing both individuals who had and those had not received a palate repair surgery, which had a high impact on the maxillary growth and occlusion. To highlight the intrinsic facial and intraoral features of Apert syndrome, five Japanese individuals with Apert syndrome from 5 years and 2 months to 9 years and 10 months without cleft palate were analyzed in this study. A concave profile and a skeletal Class III jaw-base relationship caused by severe maxillary hypoplasia were seen in all patients. The patients exhibited anterior and posterior crossbites possibly due to a small dental arch of Maxilla.
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Affiliation(s)
- Hitomi Kakutani
- Clinical Department of Orthodontics, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshiaki Sato
- Department of Orthodontics, Division of Oral Functional Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | | | - Fumio Saito
- Department of Orthodontics, Division of Oral Functional Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiko Oyama
- Clinical Department of Plastic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Junichiro Iida
- Department of Orthodontics, Division of Oral Functional Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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Bütow KW, Zwahlen RA, Morkel JA, Naidoo S. Pierre Robin sequence: Subdivision, data, theories, and treatment - Part 3: Prevailing controversial theories related to Pierre Robin sequence. Ann Maxillofac Surg 2016; 6:38-43. [PMID: 27563605 PMCID: PMC4979340 DOI: 10.4103/2231-0746.186135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Context: The disorder currently accepted as Pierre Robin syndrome/anomaly/sequence (PRS) has been plagued by controversy ever since initially being described. Controversy exists not only about the appropriate terminology and etiopathogenesis of the disorder but also about its management. Therefore, clinical findings and treatment outcomes of a large database of 266 PRS cases were compared with the current state of knowledge in the scientific literature related to history, clinical description, diagnostic criteria, epidemiology, theories of oligohydramnios, mandibular catch-up growth, midfacial hyperplasia, and the early management. Aim: The aims of Part 3 debate the controversial biological theories relating to PRS. Materials and Methods: Oligo-/poly-hydramnios, mandibular catch-up growth, and midfacial hyperplasia, the three in the literature most prevailing theories related to PRS, have been compared and discussed with the findings provided by this large database of 266 Siebold-Robin sequence (SRS) and Fairbairn-Robin triad (FRT) cases. Results: History and clinical findings evaluated in this database refute the first two theories. Although manifold midfacial appearances were demonstrated in FRT cases, a third of all SRS cases presented with mid-facial hyperplasia. Conclusion: The three main biological theories regarding PRS could not be verified after thorough analysis of the database.
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Affiliation(s)
- Kurt-W Bütow
- Department of Maxillofacial and Oral Surgery, Facial Cleft Deformity Clinic, University of Pretoria, Durban, South Africa; Suite A2-Maxillofacial Surgery, The Wilgers Hospital, Pretoria, Durban, South Africa; Department of Maxillofacial Surgery, Division of Dentistry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Roger Arthur Zwahlen
- Discipline of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong S. A. R., PR China
| | - Jean A Morkel
- Department of Maxillo-Facial and Oral Surgery, University of the Western Cape, Cape Town, South Africa
| | - Sharan Naidoo
- Department of Maxillofacial and Oral Surgery, Facial Cleft Deformity Clinic, University of Pretoria, Durban, South Africa
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18
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Li H, Dai J, Si J, Zhang J, Wang M, Shen SG, Yu H. Anterior maxillary segmental distraction in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate. Int J Clin Exp Med 2015; 8:16022-16028. [PMID: 26629107 PMCID: PMC4658996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 08/18/2015] [Indexed: 06/05/2023]
Abstract
Anterior maxillary segmental distraction (AMSD) is an effective surgical procedure in the treatment of maxillary hypoplasia secondary to cleft lip and palate. Its unique advantage of preserving velopharyngeal function makes this procedure widely applied. In this study, the application of AMSD was described and its long-term stability was explored. Eight patients with severe maxillary hypoplasia secondary to CLP were included in this study. They were treated with AMSD using rigid external distraction (RED) device. Cephalometric analysis was performed twice at three time points for evaluation: before surgery (T1), after distraction (T2), and 2 years after treatment (T3). One-way analysis of variance was used to assess the differences statistically. All the distractions completed smoothly, and maxilla was distracted efficiently. The value of SNA, NA-FH, Ptm-A, U1-PP, overjet and PP (ANS-PNS) increased significantly after the AMSD procedure (P < 0.05), with the mean overjet increased by 14.28 mm. However, comparison of cephalometric analysis between T2 and T3 showed no significant difference (P > 0.05). Changes of palatopharyngeal depth and soft palatal length were insignificant. AMSD with RED device provided an effective way to correct maxillary hypoplasia secondary to CLP, extended the palatal and arch length, avoided damage on velopharyngeal closure function and reduced the relapse rate. It is a promising and valuable technique in this potentially complicated procedure.
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Affiliation(s)
- Hongliang Li
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Jiewen Dai
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Jiawen Si
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Jianfei Zhang
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Minjiao Wang
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Steve Guofang Shen
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
| | - Hongbo Yu
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai, China
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19
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Nakayama Y, Baba Y, Tsuji M, Fukuoka H, Ogawa T, Ohkuma M, Moriyama K. Dentomaxillofacial characteristics of ectodermal dysplasia. Congenit Anom (Kyoto) 2015; 55:42-8. [PMID: 25181309 DOI: 10.1111/cga.12073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/23/2014] [Indexed: 11/29/2022]
Abstract
The aim of this retrospective hospital-based study was to elucidate the dentomaxillofacial characteristics of ectodermal dysplasia. Six Japanese individuals (one male and five female; age range, 12.7-27.2 years) underwent comprehensive examinations, including history recording, cephalometric analysis, panoramic radiography, and analysis of dental models. All the subjects had two or more major manifestations for clinical diagnosis of ectodermal dysplasia (e.g., defects of hair, teeth, nails, and sweat glands). They presented hypodontia (mean number of missing teeth, 9.5; range, 5-14), especially in the premolar region, and enamel dysplasia. Five subjects had bilateral molar occlusion, whereas one subject had unilateral molar occlusion. The common skeletal features were small facial height, maxillary hypoplasia, counterclockwise rotation of the mandible, and mandibular protrusion. Interestingly, the maxillary first molars were located in higher positions and the upper anterior facial height was smaller than the Japanese norm. The results suggest that vertical and anteroposterior maxillary growth retardation, rather than lack of occlusal support due to hypodontia, leads to reduced anterior facial height in individuals with ectodermal dysplasia.
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Affiliation(s)
- Yumiko Nakayama
- Maxillofacial Orthognathics, Department of Maxillofacial Reconstruction and Function, Division of Maxillofacial/Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Herzallah IR, Marglani OA, Shaikh AM. Variations of lamina papyracea position from the endoscopic view: a retrospective computed tomography analysis. Int Forum Allergy Rhinol 2014; 5:263-70. [PMID: 25413027 DOI: 10.1002/alr.21450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accidental injury of lamina papyracea (LP) remains one of the most common complications reported in endoscopic sinus surgery (ESS) even in most recent studies. The purpose of this study was to categorize the LP position radiologically and from an endoscopic perspective. METHODS A total of 207 computed tomography (CT) scans (414 sides) including both diseased and control groups were retrospectively reviewed by 2 examiners. Inferior turbinate attachment to the lateral nasal wall and the inferior margin of the planned middle meatal antrostomy (MMA) were identified anteriorly. Position of LP in relation to the vertical line passing through MMA inferior margin was reported. LP was categorized to lie either within 2 mm on either side of the MMA inferior margin (type I), more than 2 mm medial to the MMA line (type IIa: 2 to 4 mm; type IIb: >4 mm), or more than 2 mm lateral to the MMA line (type IIIa: 2 to 4 mm; type IIIb: >4 mm). RESULTS Of the 221 sides in the control group, 69.7% were classified as type I, 24.9% as type II, and 5.5% as type III. Among the 193 diseased operated sides examined, 60.1% were classified as type I, 20.2% as type II, and 13.5% as type III. Weighted kappa coefficient showed good interexaminer reliability. Five sides (2.6%) in the case group had accidental LP penetration intraoperatively, 4 of them were type II and type III LP. CONCLUSION This study improves surgeons' awareness of LP variations in the endoscopic field and can be of help for residents in training.
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Affiliation(s)
- Islam R Herzallah
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Egypt; Ear, Nose, and Throat (ENT) Department, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
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Silveira AD, Moura PMD, Harshbarger RJ. Orthodontic considerations for maxillary distraction osteogenesis in growing patients with cleft lip and palate using internal distractors. Semin Plast Surg 2014; 28:207-12. [PMID: 25383056 DOI: 10.1055/s-0034-1390174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The orthodontist plays a key role in the selection of the optimal treatment for patients followed by a craniofacial team. For patients with cleft lip and palate, the need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The technique of Le Fort I distraction osteogenesis of the maxilla using an internal device is potentially a predictable, stable, and convenient option for the correction of severe maxillary hypoplasia. It is an alternative option for treatment of maxillary hypoplasia in growing patients. In this article, the authors describe the orthodontist's approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is presented with a focus on the clinical aspects of treatment, using case illustrations and appropriate literature.
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Affiliation(s)
- Adriana da Silveira
- Department of Orthodontics, Dell Children's Craniofacial & Reconstructive Plastic Surgery Center, Austin, Texas
| | | | - Raymond J Harshbarger
- Department of Craniofacial & Pediatric Plastic Surgery, Dell Children's Medical Center, University Medical Center Brackenridge, Austin, Texas
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22
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Abstract
Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices.
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Affiliation(s)
- Patrick D Combs
- Department of Craniofacial & Pediatric Plastic Surgery, Dell Children's Medical Center, Austin, Texas
| | - Raymond J Harshbarger
- Department of Craniofacial & Pediatric Plastic Surgery, Dell Children's Medical Center, Austin, Texas
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Abstract
Context: Le Fort 1 maxillary osteotomy in operated patients of cleft lip and cleft palate (CLCP). Aims: To study stability of Le Fort 1 maxillary osteotomy in operated patients of CLCP by two-dimensional evaluation using cephalometric analysis. Settings and Design: Prospective study conducted at Army Dental Centre (Research and Referral) from May 2009-May 2012. Materials and Methods: Subjects included nine consecutively operated patients of CLCP with maxillary hypoplasia. Maxillary advancement by Le Fort 1 maxillary step osteotomy was performed. There were four males and five females with an age range of 16-18 years and follow-up range was 12-36 months. Presurgical and postsurgical changes were compared using cephalometrics for orthognathic surgery (COGS) system to determine stability of maxillary movement and quantify amount of relapse at 15 days and 12 months. Statistical Analysis: Student's t-test. Results: Mean linear horizontal advancement achieved along nasion (N) to anterior nasal spine (ANS) with reference to true vertical plane at 15 days and 12 months was 5.17 and 3.91 mm, respectively. The mean relapse in anteroposterior dimension was 21.63%. The mean vertical displacement observed along nasion and ANS with reference to true horizontal plane at 15 days and 12 months was 5.21 mm and 3.2, respectively with a resultant relapse of 41.54%. Conclusions: Based on clinical and COGS analysis, it is evident that Le Fort 1 advancement in operated cases of CLCP has inherent potential for relapse.
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Affiliation(s)
- Pushpa Kumari
- Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), Delhi University, Delhi, India
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24
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Dhima M, Salinas TJ, Cofer SA, Rieck KL. Rehabilitation of medically complex ectodermal dysplasia with novel surgical and prosthodontic protocols. Int J Oral Maxillofac Surg 2013; 43:301-4. [PMID: 24035129 DOI: 10.1016/j.ijom.2013.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/15/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
The functional and aesthetic needs of a 17-year-old patient afflicted with ectodermal dysplasia, chronic long-term immunosuppression, cleft palate, velopharyngeal insufficiency, hypernasality, maxillary hypoplasia, and oligodontia were met with a multidisciplinary team approach. Predictable functional and aesthetic outcomes were obtained with a combination of injection augmentation of the soft palate and nasopharynx and rigid fixation maxillary external distraction with immediate placement and immediate load protocols. No biological or prosthetic complications were noted after definitive rehabilitation with a mandibular implant-retained fixed prosthesis and a maxillary implant-retained detachable prosthesis.
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Affiliation(s)
- M Dhima
- Department of Dental Specialties, Division of Prosthetic and Esthetic Dentistry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | - T J Salinas
- Department of Dental Specialties, Division of Prosthetic and Esthetic Dentistry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - S A Cofer
- Department of Otorhinolaryngology, Division of Pediatric Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - K L Rieck
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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25
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Noh K, Kwon KR, Ahn H, Paek J, Pae A. Prosthetic rehabilitation of a cleidocranial dysplasia patient with vertical maxillofacial deficiency: a clinical report. J Prosthodont 2013; 23:64-70. [PMID: 23725034 DOI: 10.1111/jopr.12056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/28/2022] Open
Abstract
Cleidocranial dysplasia (CCD) is a rare congenital disorder characterized by skeletal and dental anomalies. This clinical report describes the prosthodontic approach to treating a CCD patient who presented with decreased facial height and relative mandibular protrusion due to maxillary hypoplasia after orthodontic treatment. Functional and esthetic rehabilitation was achieved using telescopic detachable prostheses in the maxilla and osseointegrated implants and metal-ceramic fixed dental prostheses in the mandible. These treatment approaches precluded the need for orthognathic surgical correction and presented a favorable prognosis during the 5-year observation period.
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Affiliation(s)
- Kwantae Noh
- Clinical Instructor, Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
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26
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Abstract
Crouzon syndrome, also called craniofacial dysostosis is an autosomal dominant disorder characterized by premature closure of cranial sutures, midfacial hypoplasia and orbital defects. Herein we report a case of this rare entity who presented with brachycephaly, maxillary hypoplasia, wide parrot beaked nose, repaired bilateral cleft lip and cleft palate along with dental and orbital abnormalities.
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Ren S, Ma L, Sun Z, Qian J. Relationship between palate-vomer development and maxillary growth in submucous cleft palate patients. Cleft Palate Craniofac J 2012; 51:314-9. [PMID: 22994963 DOI: 10.1597/12-051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Experimental and clinical findings suggest that the vomer is involved in facial development and might contribute to the short and retrusive maxilla in cleft patients. The aim of this study was to investigate the relationship between vomer development and maxillary growth in unoperated submucous cleft palate (SMCP) patients. Design : Retrospective cohort study. Participants : Thirty unoperated SMCP patients were included. The criteria for clinical diagnosis were: bifid uvula, a translucent zone in the midline of the soft palate, and a touchable "V" notch on the posterior border of the bony palate. There were 19 female and 11 male patients, with an age range from 3 to 25 years. Interventions : All patients were imaged using spiral computed tomography (CT) while in centric occlusion before the surgeries. Main Outcome Measures : Three-dimensional (3D) reconstruction models were created, and dentoalveolar relationships were rated by three experienced doctors according to the GOSLON score principles. The patients then were divided into three groups: 1 - normal occlusion, 2 - edge-to-edge bite, and 3 - crossbite. The vomer-palate fusion rate was calculated on 3D CT images and represented the vomer development. Results : The sagittal extent of the palatal cleft and the malformation of vomer in SMCP were greatly varied. The vomer-palate fusion rate in the crossbite group (occlusal score = 3) was significantly lower than that in the normal occlusion group (P = .027). Conclusions : Our findings suggest that correlation exists between vomer development and sagittal maxillary growth in unoperated SMCP patients.
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Sinha R, Menon PS, Venugopal MG. A clinical evaluation of midface advancement using intraoral distractors in management of bone stock deficiencies. Med J Armed Forces India 2011; 67:245-52. [PMID: 27365815 DOI: 10.1016/s0377-1237(11)60051-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 03/31/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cleft lip and palate patients present large osseous defects of the alveolus and midface hypoplasia. Traditional orthognathic surgery has limitations of relapse and limited age group. Distraction osteogenesis (DO) as a modality for midface advancement is relatively new. Modular internal distractor (MID) offers the advantage of patient compliance and minimal discomfort. The purpose of this study was to evaluate the versatility of intraoral distractors in midface advancement. METHOD Nineteen patients with midface bone stock deficiency were selected for maxillary advancement. At the first surgery under general anaesthesia, after the osteotomy (Le Fort I/II), MID system was used. After distraction, evaluation was done for ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at three stages: T1, pre-distraction; T2, post-distraction; and T3, one year post-distraction. RESULTS Significant changes showed 13.3 mm mean midface advancement bone formation at the pterygomaxillary region. The results were stable even at one year follow-up. CONCLUSION Maxillary position improved in relation to the cranial base. This study showed that the MID was versatile in midface advancement in stability and patient compliance with minimal complications.
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Affiliation(s)
- Ramen Sinha
- Professor and Vice Principal, Sri Sai Dental College, Vikarabad, Andhra Pradesh
| | - P Suresh Menon
- Professor and HOD, Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Whitefield, Bangalore
| | - M G Venugopal
- Graded Specialist, Oral and Maxillofacial Surgery, Mil Dental Centre, Base hospital, Delhi Cantt., New Delhi
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29
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Butler MG, Rames LJ, Wadlington WB. Acrodysostosis: report of a 13-year-old boy with review of literature and metacarpophalangeal pattern profile analysis. Am J Med Genet 1988; 30:971-80. [PMID: 3055990 PMCID: PMC6697261 DOI: 10.1002/ajmg.1320300416] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report on a 13-yr-old boy with acrodysostosis, a review of 30 cases in the literature, and metacarpophalangeal pattern profile (MCPP) analysis. The prominent manifestations (present in greater than 75% of cases) of this condition include nasal and maxillary hypoplasia, peripheral dysostosis, first ray hyperplasia of the foot, acromesomelic brachymelia, decreased interpedicular distance, advanced skeletal maturation and mental retardation. Results of chromosome studies have been normal. An autosomal dominant inheritance pattern was reported in two families. Maternal and paternal ages were 2 and 3 yr, respectively, above the average age of the general parent population, which suggests that advanced parental age may be a factor in the cause of this condition. A characteristically abnormal MCPP was found in our patient and in 16 additional cases studied from the literature. A mean MCPP was developed for the syndrome. MCPP analysis may be useful as a diagnostic tool in patients suspected to have acrodysostosis.
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Affiliation(s)
- M G Butler
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232
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