Comparison of three-dimensional soft tissue changes according to the split pattern after sagittal split osteotomy in patients with skeletal class III malocclusion

OBJECTIVES

This study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy.

MATERIALS AND METHODS

Patients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect.

RESULTS

A total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0-T1 (p = 0.02), T0-T2 (p = 0.03), and T0-T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group.

CONCLUSIONS

We found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback.

CLINICAL RELEVANCE

It is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism.

Urinary microRNAs can predict response to abiraterone acetate in castration resistant prostate cancer: A pilot study

BACKGROUND

Despite novel agents have been introduced to treat castration resistant prostate cancer (CRPC) during the last decade, up to one-third of CRPC patients face primary resistance to new generation compounds. Therefore, sensitive molecular tools are urgently needed for reliable treatment selection and response prediction. This study aimed to evaluate urinary miRNAs and blood circulating androgen receptor (AR) transcript level as a tool for noninvasive outcome prediction for CRPC patients undergoing abiraterone acetate (AA) therapy.

METHODS

Prostate cancer-specific miR-148a, -365, -375, and -429 were analyzed in 129 urine samples collected from 100 CRPC patients before and during AA therapy via quantitative reverse transcription PCR. To test the prognostic value, urinary miRNA levels alone, as well as combined with AR level were associated with progression-free survival (PFS) and overall survival (OS).

RESULTS

Level of urinary miR-375 was the highest in CRPC in comparison to noncancerous controls, as well as in combination with miR-429 was predictive for short PFS in AA-treated patients (HR = 2.2, 95% CI: 1.1-4.2, p = 0.023). Especially high prognostic power of all analyzed miRNAs was observed in CRPC cases with high blood AR levels. For PFS prediction a tandem of miR-429 and high AR reached HR of 5.0 (95% CI: 2.2-11.8, p < 0.001), while for prediction of OS the best combination was demonstrated by miR-148a and AR with HR of 3.1 (95% CI: 1.4-7.1, p = 0.006).

CONCLUSIONS

Urinary miRNAs could be used as prognostic biomarkers for CRPC patients to predict response to AA therapy, especially for the cases with high blood AR levels.

Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians

BACKGROUND

Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony.

METHODS

Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD.

RESULTS

Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness.

CONCLUSIONS

This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour.

LEVEL OF EVIDENCE IV

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 .

Automated Real-Time Evaluation of Condylar Movement in Relation to Three-Dimensional Craniofacial and Temporomandibular Morphometry in Patients with Facial Asymmetry

The aim of this study was to investigate the correlation between craniofacial morphology, temporomandibular joint (TMJ) characteristics, and condylar functional movement in patients with facial asymmetry using an up-to-date automated real-time jaw-tracking system. A total of 30 patients with mandibular asymmetry and prognathism were included. Three-dimensional (3D) craniofacial and TMJ morphometric variables were analyzed in images captured using cone-beam computed tomography. Three-dimensional condylar movements were recorded during the opening, protrusion, and laterotrusion of the jaw and divided into those for deviated and non-deviated sides. Overall functional and morphometric variables were compared between the sides by a paired t-test. Pearson’s correlation analysis and factor analysis were also performed. As a result, significant differences were found between the sides in morphometric and functional variables. The condylar path length was significantly longer and steeper on the deviated side during protrusion and lateral excursion. TMJ morphometric asymmetry, more so than the craniofacial morphologic asymmetry, seemed to be reflected in the functional asymmetry, representing different correlations between the sides, as supported by factor analysis. This study provides evidence explaining why the asymmetric condylar path remained unchanged even after orthognathic surgery for the correction of craniofacial asymmetry.

Changes in the position of the condyle after bilateral sagittal split ramus osteotomy in patients with mandibular retrusion and protrusion: a new condyle: fossa matching concept

The purpose of this study was to compare the condylar positional changes after bilateral sagittal split ramus osteotomy (BSSRO) in patients with mandibular retrusion and those with mandibular prognathism. We also studied the correlation between the degree of matching of the condyle and fossa, and condylar displacement. Thirty patients with mandibular retrusion (n=11) or mandibular prognathism (n=19) who underwent BSSRO were included. The condylar position was assessed from spiral computed tomographic (CT) scans taken preoperatively, during the first postoperative week, and at least 6 months postoperatively. All data were measured by MIMICS 17.0 and analyzed by Student's t test and Pearson's correlation analysis. The size of the condyles of patients with mandibular retrusion was significantly less than those of patients with mandibular prognathism (491.5 (172.8) compared with 823.2 (212.0) mm³). The size of the glenoid fossa in those with mandibular retrusion (599.6 (110.4) mm³) and those with prognathism (597.6 (151.6) mm³) did not seem to differ. Postoperatively the condyles moved outwards, backwards, and downwards in both groups of patients. Correlation analysis between the condyle:fossa volume ratio and the condylar positional changes showed that a large condyle:fossa volume ratio correlated with the smaller positional changes in the condyle. The condylar position changed immediately after mandibular advancement and setback, and persisted in the long term. Larger condyles tended to have fewer positional changes.

[Diagnostic classification for malocclusions with facial prognathism and its incorporation into mandibular morphological analysis]

Since its introduction, the diagnostic classification for malocclusions with facial prognathism has been well recognized and practically applied in orthodontic specialty. According to this classification, the malocclusions with a prognathic facial profile can be categorized into 4 classes: dento-alveolar originated, skeletally originated, mandibular positioning and combined skeletal and mandibular positioning, i.e, combined subtype I and subtype II. Among the new developments of this innovative malocclusion classification, the morphological assessment of mandibular body highlights a new impetus. Other than measuring the angular and linear perimeters only, this new dogma focuses on evaluating the physical contours of the mandible through cephalometric images. It includes the determination of geometric morphology of the mandible and the depth of symphysis curvature. Two types of mandibular morphology are common in patients with facial prognathism: a favorable flat and horizontally rectangular body with a prominent chin; and a unfavorable thick and vertically triangular body with a retrusive chin. The depth of the symphysis, on the other hand, is shown to be shallow or deep. It is noted that the prognathism with mandibular retruded positioning has a flat mandible and unfavorable triangle-shaped mandible exists only in skeletal prognathism. This new classification restricts the extraction indications for malocclusions with a prognathic facial profile: extraction should be refrained in cases with increased overjet, overbite and deep curve of Spee, and SGTB orthopedic therapy, instead, is recommended.

[The classification of malocclusions with facial prognathism and its clinical implications]

Severe skeletal malocclusions with facial prognathism keep high prevalence in Chinese population. The classification and diagnosis of these malocclusions remain challenging due to the complicity and variety in their clinical manifestations, cephalometric morphologies and perceived etiologies. Based on elaborated studies about the extensive clinical archives and records, this article introduced an innovative classification of this specific anomaly, which not only provides with diagnostic specifics, but also indicates the possible etiologies and therapeutic guidance.

Triple negative breast cancer: the role of metabolic pathways

The incidence of breast cancer in Malaysia and other Asian countries is on the increase, reflecting lifestyle changes some of which are known risk factors for the development of breast cancer. Most breast cancers are amenable to adjuvant therapies that target hormone receptors or HER2 receptors on the surface of the cancer cells and bring about significant improvement in survival. However, approximately 17% of Malaysian women with breast cancer, present with tumours that are devoid of these receptors and are consequently termed 'triple negative' breast cancers. These triple negative breast cancers typically occur in women of a younger age than receptor positive cancers, are predominantly of high grade tumours and the prognosis is usually poor. There is therefore a pressing need to understand the biological pathways that drive these tumours, in order that effective strategies are developed to treat these aggressive tumours. With the increasing affluence of developing countries, obesity and Type II Diabetes are also on the rise. These diseases are associated with an increased risk of developing a range of cancers including those of the breast. In particular, the metabolic syndrome has been shown to be associated with triple negative breast cancer. This article reviews some of the metabolic pathways and biomarkers which have been shown to be aberrantly expressed in triple negative breast cancer and highlights some of the ongoing work in this area.

[Detection to changes in hyoid and tongue positions, and pharyngeal airway following mandibular setback surgery by cone beam CT]

OBJECTIVE

To observe changes in tongue and hyoid position, and pharyngeal airway in patients with skeletal class III malocclusion after the combined orthodontic and orthognathic treatment.

METHODS

Twenty patients were involved in this study. Cone beam CT (CBCT) was performed on patients one week before and six months after treatment. Raw data were reconstructed into three-dimensional model. To set up a three-dimensional reference frame, which was based by point "S", the sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed. The three-dimensional position changes of chin, hyoid bone and tongue were measured in order to analyze the amount of mandibular setback relationship with the changes of pharyngeal airway, hyoid bone and tongue positions.

RESULTS

After treatment, the pharyngeal airway was constricted significantly. The hyoid significantly moved inferoposteriorly by 5.72 mm (backward) and 2.76 mm (downward) and the tongue moved posteriorly by 4.04 mm after surgery (P < 0.05). Among the 19 correlated indexes between the amount of mandibular setback and other measurements, 14 of which were significantly correlated (P < 0.05). The strongest correlation was found between the amount of mandibular setback and total volumes of pharyngeal airway (r = 0.834, P < 0.01).

CONCLUSION

Following combination therapy, the pharyngeal airway space decreased, the hyoid moved inferoposteriorly and tongue moved posteriorly. There were great correlations between the amount of mandibular setback and the changes.

[Investigation on facial profile preferences of orthodontic patients]

PURPOSE

To investigate facial profile preferences of orthodontic patients and determine whether the patient's age and sex were influential factors in the esthetic perception for providing reference for clinical practice.

METHODS

Profile digital photographs of each patient were used. Changes in facial convexity were established by altering the position of mandible incrementally with Photoshop 7.0. Thus profile images of various degrees of mandiblular anteroposterior discrepancy for each patient was generated. Then an electronic questionnaire was designed and administered to investigate tolerable boundary values for mandibular retrognathism, tolerable boundary values for mandibular prognathism and most pleasing profiles of 203 subjects (average age 19.2±6.0 years; 70 males, 133 females). Differences between male and female profiles in the esthetic perception of patients were analyzed by Wilcoxon matched-pairs signed ranks test. Comparison of esthetics perception for male and female profiles regarding patient's sex and age was made by Wilcoxon rank sum test of two independent samples. All statistical analysis was performed using SPSS 17.0 software package.

RESULTS

The zone of acceptability of facial convexity was 168°-180° for male model and 160°-172° for female model. The most pleasing profile was 172° for male and 168° for female. There was no significant difference between male and female patients in facial profile preferences (P>0.05). The differences in facial profile preferences between adult group and immature group were statistically significant (P<0.05). In the comparison of age groups, the adult group preferred bigger facial convexity angles than immature group for male and female retrognathia profile, male prognathia profile and male most pleasing profile.

CONCLUSIONS

The zone of acceptability of facial convexity and the most pleasing profile exist in patients' esthetic perception of profile. There is difference between male and female profiles in the esthetic perception. The facial profile preferences of orthodontic patients are influenced by age, not by sex.

[Electromyographic activity of sternocleidomastoid and masticatory muscle in patients with prognathism]

OBJECTIVE

To investigate the electromyographic activities of anterior temporalis (TA), masseter muscle (MM), digastric anterior (DA), sternocleidomastoid (SCM) at postural position (MPP) and various mandibular movements in prognathic patients.

METHODS

Thirty-two patients with prognathism were selected from the clinic of oral and maxillofacial surgery of China Medical University. 36 healthy college students with normal occlusion were selected as normal controls. A BioEMG II diagnostic system with BioFLEX surface electrode was used to record the electromyographic activities of the above muscles.

RESULTS

Compared with the control group, the electromyographic activities of TA, SCM and DA in prognathic patients were higher in MPP. The electromyographic activities of TA, MM were significantly lower than the control group in clenching (P < 0.01). In protrusion, the electromyographic activities of TA, MM and SCM in prognathic patients were higher than the control group (P < 0.01). In retrusion, the electromyographic activities of TA, SCM in prognathic patients were higher than the control group (P < 0.01).

CONCLUSION

The masticatory muscles electromyographic activity of prognathism is abnormal.

Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff

BACKGROUND

When the Mini Nutritional Assessment (MNA) was developed, the authors did not specifically focus on the nursing home setting. Due to a number of particularities of nursing home residents, such as cognitive and linguistic disabilities, a number of uncertainties with regard to its application await clarification.

AIMS AND OBJECTIVES

The aim of this study was to compare the results of two different modes of MNA application in nursing homes: resident interviews versus assessment by nursing staff.

METHOD

The MNA was applied to 200 residents of two municipal nursing homes in Nuremberg, Germany. First one-on-one interviews of the residents were conducted by two researchers from our group. Next, the MNA was applied by the attending nursing staff who was blinded to the results of the first MNA. To evaluate the prognostic properties of the two different approaches, data on mortality of the screened residents were collected during a six-month follow-up period.

RESULTS

Among 200 residents (f 147 m 53, f 86.5 +/- 7.4 y. m 83.0 +/- 8.5 y.), the MNA could be applied to 138 residents (69.0%) by one-on-one interviews and to 188 residents (94.0%) by the nursing staff. 15.2% of the residents were categorised as malnourished by the interviews and 8.7% by the nursing staff's assessment. The agreement of the two forms was low for the MNA short form (weighted kappa = 0.31; 95% CI: 0.14 - 0.47) as well as for the full MNA (weighted kappa = 0.35; 95% CI: 0.27 - 0.44). After exclusion of residents with cognitive impairment (n=89), agreement for the full version increased (weighted kappa = 0.47, 95% CI 0.25 - 0.68). 25 (12.5%) study participants deceased during the follow-up period. Mortality was significantly associated with the mortality for both approaches, while the MNA application by the nursing staff proved to be superior (nursing staff p < 0.001, residents p < 0.05).

CONCLUSIONS

The results of the MNA in nursing home residents may differ substantially when resident interviews are compared to assessment by nursing staff. The authors recommend that the MNA should be routinely applied by the nursing staff. The application rate is higher and interference with cognitive as well as linguistic deficits is lower. In future studies, the mode of MNA application in nursing home residents should be clearly stated to facilitate comparability of results.

[The position and course of mandibular canal through mandibular ramus in patients with prognathism]

PUEPOSE: To investigate the position and course of mandibular canal through mandibular ramus in patients with prognathism using computed tomography, and to relate the findings to sagittal split ramus osteotomy, and also to describe the anatomical variability of mandibular canal in order to reduce injuries to the inferior alveolar nerve.

METHODS

The mandibles of 45 patients with skeletal Class III prognathism undergoing sagittal split ramus osteotomy were examined by spiral computed tomography. The region from a plane containing the lowest point of mandibular foramen(base plane 0) to 25 mm below it was measured with 5 mm distance every plane. The following parameters were measured: total thickness of mandible through the center of mandibular canal, thickness of buccal and lingular cortical plate, and narrowest portion of bone marrow space between the outer mandibular canal and both the buccal and lingular cortex. All measurements were analyzed with SPSS 13.0 software package.

RESULTS

The thickness of mandible increased from the mandibular formen to mandibular body, there was no statistical difference among the sites with regards to the inner diameter of mandibular canal (F=1.044,P=0.391). The width of bone marrow space at the buccal side was significantly different between 3,4 plane and 0 plane,and the measured widths on the lingual side were significantly increased. The width of the buccal side bone marrow space at each site could be classified into three types, the separate type was most prevalent in this study(n=391 of 456,85.5%), contact and fusion type were 12.71% and 1.54% respectively. There was no significant difference between the left and right side.

CONCLUSION

On average, the mandibular canal is situated more lingually at all sites, and the width of bone marrow space at the buccal side is more narrow at 15-20mm below the mandibular foramen. When the width of marrow space at buccal side is absent, especially the fusion type, it is suggested to select an other procedure rather than sagittal split ramus osteotomy.

Dental management of a child with trisomy 9 mosaicism: a case report

This case report presents the dental management of a 13-year-old girl with mosaic trisomy 9. She had: (1) severe psychomotor retardation; (2) short stature; (3) progressive microcephaly; (4) flat feet; (5) genu valgum; and (6) severe kyphoscoliosis. Dysmorphic facial features included: (1) maxillary prognathism; (2) narrow high-arched palate; (3) short philtrum; (4) small low posterior dysplastic ears; and (5) down slanting palpebral fissures with right eye ptosis. The case report describes initial treatment under general anesthesia and further treatments using conscious sedation. Emphasis was placed on the need to adjust the treatment to patient's skeletal malformations and respiratory problems by adjusting her ability to sit in the dental chair in an upright position. Supernumerary premolars and opalescent changes of the maxillary incisors might be part of the clinical features related to trisomy 9 mosaic syndrome.

[Clinicopathological study of salivary duct carcinoma]

Salivary duct carcinoma (SDC) was first described by Kleinsesser in 1968 and was classified as an independent entity by the 1991 Revised World Health Organization. It is a rare but highly malignant tumor. We reviewed pathology in 49 cases of salivary adenocarcinoma, and diagnosed 6 cases as SDC. All had a rapidly enlarged mass in the parotid gland. All were men, and 4 involved facial palsy and metastasis to cervical lymph nodes. Fine needle aspiration biopsy was conducted in 3 cases, but none was diagnosed as SDC. Two had chemotherapy, but showed no effect. All underwent surgery, but only 1 survived more than 4 years. Immunohistochemically, none showed s-100 protein. Four showed PCNA and p53 protein. Highly positive cells of PCNA and p53 were found around comedo necrosis.

"Large cell/anaplastic" medulloblastomas: a Pediatric Oncology Group Study

495 medulloblastomas (MBs) from 6 Pediatric Oncology Group (POG) protocols were reviewed to assess the incidence and prognostic significance of "large cell" and "anaplastic" variants. "Large cell" medulloblastomas (LC MBs) were those with focal or diffuse, large, round neoplastic cells with prominent nucleoli. "Anaplastic" MBs (A MBs) were those with nuclei that were also large but markedly atypical with coarse chromatin and irregular shapes. Twenty-one cases were identified in the combined LC/A MB group, comprising about 4% of all MBs. Survival curves and Kaplan-Meier estimates of survival probabilities were examined separately for the LC/A MB and control groups. The logrank test for detecting poorer survival in the 21 cases was significant (p < 0.0001). Fluorescence in situ hybridization for c-myc showed amplification in 4 of 11 cases of the LC/A phenotype and 1 additional case of high level gain at 8q24 was disclosed by comparative genomic hybridization. Comparative genomic hybridization confirmed c-myc amplification and found evidence for isochromosome 17q in 3 of 4 LC/A cases studied successfully. One additional tumor showed high level gain restricted to 2p13 consistent with n-myc amplification. Monosomy 22, common in atypical teratoid/rhabdoid tumors, was not found. These results suggest that LC/A MB phenotype could be, at least in part, a correlate of c-myc, and possibly n-myc, amplification. The study thus confirms original observations about the LC MB in regard to histological features, immunohistochemical findings, c-myc amplification, cytogenetic findings, and poor prognosis.

Abdominal vena caval injuries: outcomes remain dismal

BACKGROUND

The mortality rate for abdominal vena caval injuries remains high. We examined the experience of a level I trauma center to determine factors significant to the outcome in these injuries.

METHODS

Forty-seven patients were identified in a retrospective review (1989 to 1999) of patients were identified with abdominal vena caval injury. Data were analyzed by uni- and multivariate methods, including logistic regression.

RESULTS

Most of the individuals with abdominal vena caval injuries were young male patients who were injured by penetrating trauma and who were hypotensive on arrival. The severity of injury and the number of organs injured was high. The overall mortality rate was 55%. Nonsurvivors were more often hypotensive in the field with physiologic derangement consistent with hemorrhagic shock. Type and location of injury as well as method of repair were associated with death. Multiple regression analysis revealed that prehospital initial systolic blood pressure and intraoperative bicarbonate levels were independent predictors of survival.

CONCLUSIONS

We identified factors related to poor outcome, including suprarenal and retrohepatic location of injury and variables that reflected the evolution of shock. Management should include appropriate resuscitation and ultimately may require novel operative techniques.

Active mandibular protrusion in the rational treatment of skeletal Class II malocclusions

BACKGROUND

Aim of the present study is to assess the ideal mandibular protrusion exercises, which should always be associated with functional treatment of skeletal Class II malocclusions, characterized by mandibular hypoplasia.

METHODS

The study was carried out on a sample including 8 growing subjects (mean age 10.6 years +/- 0.6), similar in age and biotypology (mandibular hypoplasia; normodivergent growth pattern). The electromyography (EMG) activity of the superficial bundle of the masseter (considered as an accessory protrusive muscle) was bilaterally recorded at rest and, during voluntary contraction, at different degrees of protrusion (minimum, medium, maximum), condition dynamically analyzed at various times of contraction (initial, 5, 10, 30 seconds). The mean values of the recruitment pattern during the whole contraction, the number of turns/sec and the ratio turns/mean amplitude were evaluated.

RESULTS

The data obtained by means of a precise electromyographic analysis suggest that the ideal exercise for an active mandibular protrusion should be a medium degree contraction lasting 10 seconds. These results are consistent with the linear relationship between muscle force and EMG amplitude, correlation effective only up to 60% of the exerted force, because of the muscular fatigue appearing beyond this threshold. During such a muscular fatigue, due to maximum contraction, it is possible to observe a progressive decrease in the EMG activity, owing in particular to the motor-neuron reduced discharge-frequency.

CONCLUSIONS

This result suggests a small benefit of long-lasting muscular contractions, both in maximum and in medium protrusion movements, for re-educational purposes. Only during the medium-degree, 10 sec-lasting contraction it's possible to point out a turns-number variation significant of an active and constant contraction, which decreases if long-lasting (30 sec).

Trichodentoosseous (TDO) syndrome: case report and literature review

Trichodentoosseous (TDO) syndrome is an autosomal dominant condition characterized by dysplastic nails, curly hair, bone sclerosis of the long bones and calvarium, taurodontism, and enamel hypoplasia that occurs with hypomaturation/hypocalcification defects. To date, nine previous case reports of TDO in the dental literature have shown that while taurodontism and enamel defects are consistently present in TDO, the changes in the nails, hair, and bones may be variably expressed and occasionally not noted. Because of this, a few previous cases of TDO syndrome had been diagnosed simply as amelogenesis imperfecta. This case report highlights the typical clinical findings, diagnostic problems, and the clues to diagnosing this interesting condition. Clinical management of TDO is centered on preventing dental abscesses with stainless steel crowns and improving appearance with esthetic restorations.

An American Board of Orthodontics case report: the nonsurgical orthodontic correction of a Class III malocclusion

A case report about the orthodontic treatment of a Class III malocclusion in a black man 22 years 8 months old. The patient's chief complaint concerned the space left by the traumatic loss of the maxillary left central incisor. Not desiring changes in facial appearance, the patient sought an orthodontic solution to his problem. An acceptable result was achieved through maxillary expansion and the reduction of mandibular space. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

New oral-acral syndrome with partial agenesis of the maxillary bones

We report on a woman with congenital defect of the anterior part of the maxillary bone (including absence of incisors and canines) without cleft lip or palate, and ectrodactyly of the feet. This syndrome appears to represent a new entity of unknown cause.

Winchester syndrome. A case report and literature review

The mucopolysaccharidoses are a group of inherited lysosomal storage diseases that are caused by a deficiency of specific enzymes. The acid mucopolysaccharides are stored in tissue and excreted in large quantities in the urine. The storage of this material leads to effects on a wide variety of tissues and to remarkable changes in morphologic features. Winchester syndrome is a rare disorder in the group of mucopolysaccharidoses. This article is a report of a case with classic clinical, radiologic, and biochemical characteristics of the Winchester syndrome.

Cranial base angulation and prognathism related to cranial and general skeletal maturation in human fetuses

The purpose of the present study was to describe normal midsagittal craniofacial morphology in second trimester human fetuses. Measurements of the cranial base angle and the prognathism of the maxilla and the mandible were performed on radiographs of cranial midsagittal tissue blocks of 52 fetuses with a gestational age from 13 to 27 weeks. Special procedures were developed for the definitions of the nasion and sella reference points on the radiographs in the early stages of fetal development. Mean data were reported for stages of crown rump length (CRL) and maturation of the fetal cranial base (MSS), usable as reference in assessment of pathological fetal crania in reports and autopsy procedures. Regression equations were determined for the regression of the angular values on CRL, MSS, and general skeletal maturation (TNO). The cranial base angle was found to decrease significantly, and the angles of prognathism to increase significantly with increasing CRL, TNO, and MSS values. It was suggested that these simultaneous and similar changes in the three angles could be accounted for by the upwards movement of the sella point produced by a cranial displacement of the pituitary fossa caused by local cartilagenous growth and bony remodelling during the period of study. The study thus reflects the influence of cranial skeletal maturation on the early development in shape of the craniofacial complex.

Precocious puberty in a boy with a widespread linear epidermal naevus

A 7-year-old boy with a systematized verrucous epidermal naevus, multiple pigmented naevocytic naevi and precocious puberty is described. The possible basis for this previously unreported association of abnormalities is discussed.

Dental anomalies in fucosidosis

Dental anomalies have not previously been recorded in patients with fucosidosis. A new case of this rare disorder is reported, in which a number of variations in both number and morphology of the primary and secondary dentition occur.

[Complete removable dentures and prognathism]

Further to some reminders concerning terminology and resorption, this article presents the full denture prosthetic treatment for two patients with total edentation and a prognathic malocclusion. The first case presents a tridimensional symptomatology, described by: a progeny; a voluminous mandibular terrain; a concave profile; a rather closed mandibular angle; a mandible ridge which circumscribes the upper jaw; The particularities of the prosthetic treatment in this case are: a lowering of the posterior occlusal plane; a mounting of the teeth in a limited external position, that is to say, the maxillary lingual cuspids and the mandibular mesio-distal groove on the inter-crest line; the mandibular incisors and cuspids placed with a lingual inclination to obtain an edge-to-edge occlusal contact. The second case is of vertical symptomatology type, described by: a macrogeny; a moderate concavity of the profile; a very marked increase of the vertical dimension; an open mandibular angle; a short ramus; a long mandibule; a very marked overjet between the anterior crests. The particularities of the prosthetic treatment for this case are: a posterior teeth placement, avoiding cross-bite position, taken into account the strong convergence of the intercrest lines; a strong lingual inclination of the mandibular incisors and cuspids, in order to obtain an edge-to-edge occlusal contact. In the light of these two specific cases, emphasis is placed on the particularities of the treatment and on the teeth placement proposed in order to avoid any cross-bite teeth mounting.

[The influence of playing the clarinet on the dentomaxillofacial morphology and function]

The purpose of this experiment is to understand the influence of playing the clarinet on the dentomaxillofacial morphology and function. The 12 subjects, selected at random (all adults, 4 men and 8 women) had played the clarinet for more than 10 years. The subjects had anamnesis, oral photo pictures, facial photo pictures, cast model, lateral cephalograms (lateral cephalo) and frontal cephalograms (frontal cephalo) taken when they were in centric occlusion and playing the clarinet. The results were as follows: 1. The facial profile and occlusal relation depend on the subjects. (2 mandibular retrognathism. 4 prognathism and 6 crowding.) 2. No characteristic skeletal pattern was found compared with controls in angle measurement but subjects had a tendency to have large facial height in linear measurement of lateral cephalo. And in denture pattern the lower incisors were linguoclination. 3. Concerning the lateral cephalo, we noticed that the angle of the clarinet in relation to the body axis increased in accordance with the prognathism and decreased with the retrognathism. 4. The subjects don't have identical midline, comparing lower midline to dentofacial midline, when playing, the angle of clarinet to the body was eccentric according to maxillary incisors in frontal cephalo. 5. Anterial and posterial length was short in mandibular arch, analyzing the cast model. 6. The pressure on mouthpiece increased in accordance with the prognathism and decreased with retrognathism. 7. The results of the EMG analysis indicated that the muscle activity of oral sphincter was described as 1). upper lip, 2). lower lip, 3). commisure of lips and differences were found depending on the parts being studied and the sound played on the clarinet. In conclusion, the skeletal and denture problem influence the holding position of the clarinet, embouchure and the way of playing it. In case of mandibular prognathism, when playing, the subjects pressed on their teeth with the clarinet. So B instrument won't do for prognathism because lower incisors are pushed inward as a result.

[Diagnostic approach to basocellular nevomatosis from a dental point of view. Apropos of a new case]

A new case of basal cell naevomatosis, localized in the jaws as odontogenic keratocysts, is described and the importance of the diagnostic role plaid by the dentist is underlined. Skin lesions, bone involvements and the hereditary character of the disease are described. Special emphasis is given to the importance and the easy accessibility of the oral manifestations. Possible evolution towards advanced forms, and the heterogeneity of the symptoms lay the stress on the need of an early diagnosis and the necessity of a close collaboration with the various specialists concerned.

[Cleidocranial dysostosis. Presentation of a clinical case]

After presenting the aetiopathogenetic, clinical, radiological and therapeutic aspects of cleidocranial dysostosis syndrome, a case is reported. The patient, a boy of 14, was the subject of examination since birth.

Long-term mandibular adaptations to protrusive function: an experimental study in Macaca mulatta

Twenty-three male juvenile rhesus monkeys (Macaca mulatta) were used in an experimental study of long-term mandibular adaptations to induced protrusive function. Serial protrusive appliances were placed in 11 experimental animals and mandibular adaptations were monitored cephalometrically. Twelve animals were used as controls. After 48 weeks significant increases in increments of condylar growth and in overall mandibular length were noted in the treated animals. At the end of the 144-week experimental period, the mandibles of the treated animals were 5 to 6 mm longer than those of the control animals. The results of this study do not support the hypothesis that the mandible has a genetically predetermined length.

X-linked mental retardation, macro-orchidism, and the Xq27 fragile site

Twenty-three families with X-linked mental retardation were examined for the presence of a fragil site on the long arm of the X chromosome (Xq27 fra). Specific culture media were necessary to demonstrate this site. In only seven of the families was the Xq fragile site observed; in these, all of the affected males had both the fragile X and macro-orchidism. Macro-orchidism was not observed in the remaining 16 families. In the families with Xq27 fra segregating the fraes. This correlated with the age of the carrier. The 25 affected males with macro-orchidism and Xq27 fra had some minor clinical features in common: there was an increase in birth weight, high forehead, prognathism, pale irides, big ears, and an increased head circumference in infancy and childhood which did not persist into adult life. The majority of the affected individuals were moderately retarded.

Bimaxillary protrusion as a pathologic problem in the Thai

The purpose of the study was to determine the nature and occurrence of bimaxillary protrusion in seventy-five students of the Faculty of Dentistry, University of Chiangmai, Thailand. The average age of the subjects was 22 years. Growth and development of facial dimensions were in a relatively stable configuration. Procedures included an evaluation of cephalographs, models, and photographs and an analysis of habits. A Steiner's analysis revealed the significance of the interincisal relationship for bimaxillary protrusion. In all cases the interincisal angle was below 124 degrees. In comparison with cases having an interincisal angle above 124 degrees, there was an increase in problems such as mouth breathing and tongue and lip habits, as well as a relative increase in tongue volume. Results of the study indicate that the etiology of bimaxillary protrusion is complex, involving environmental factors, soft-tissue function, volume, and habit.

Cephalometric findings in two cases with unrepaired bilateral cleft lip and palate

Two cases with unoperated bilateral cleft lip and palate were examined clinically and cephalometrically and compared to matched normals. The findings indicate a severe premaxillary skeletal protrusion which results in a maxillary-mandibular discrepancy. The maxillary incisor inclination was acceptable, while the mandibular incisors were relatively more lingually inclined in the cleft group. Surgical management of one case necessitated premaxillary resection.