Effect of an Intraoral Retrusion Plate on Maxillary Arch Dimensions in Complete Bilateral Cleft Lip and Palate Patients

Objective

The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure.

Patients

The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate.

Results

The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly.

Conclusion

From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer.

Young female with acromegaloid features and pituitary macroadenoma: what is your diagnosis?

Pseudoacromegaly is a extremely rare condition previously described and characterized by acromegaloid changes, tissue overgrowth, without elevations in insulin-like growth factor or growth hormone as seen in Acromegaly. We present the case of a young female seen initially with acromegaloid features and a pituitary microadenoma. After work-up the patient was diagnosed as insulin-mediated pseudoacromegaly. Only a few cases of pseudoacromegaly has been reported and should always be considered when evaluating patients for acromegaloid features with negative biochemical and hormonal levels.

Homocystinuria and oral health. A report of 14 cases

The aim of this study was to explore the oral health in Swedish individuals with the diagnosis of homozygote cystathionine beta synthase-deficient homocystinuria (HC), a rare disorder of amino acid metabolism affecting connective tissue, in which the phenotypic abnormalities include dislocation of the optic lens, skeletal abnormalities, thromboembolic events, and sometimes mental retardation. Further aims were to evaluate the oral findings against previous oral observations in a medical case report, such as high narrow palate, mandibular prognathia, crowding and early eruption of teeth. Every hospital in Sweden was contacted, with the inquiry of patients with diagnosis of HC,which resulted in 14 individuals participating in oral clinical examination. The oral findings evaluated against previous medical case reports showed to be partly in accordance with previous observations. Dental health showed to be compromised in a majority of cases. Together with the fact that methionine restriction (low-protein diet) is involved in the treatment of the condition and might result in a diet high in sugars, this points out the role of regular dental checkups and preventive oral care for individuals suffering from HC. In addition, short dental roots were a finding not previously reported in the literature. All the studied cases had central maxillary incisors with short roots, when compared to reference values used.

Orofacial aspects in Noonan syndrome: 2 case report

Noonan syndrome (NS) is an autosomal dominant disorder characterized by dysmorphic facial features in association with short stature and heart disease. A webbed neck, chest deformities, mental retardation, and bleeding disorders are also frequently associated with this pathology. NS is relatively common, with an estimated incidence of 1 per 1,000 to 1 per 2,500 live births. Many cases have been reported in the dental literature, yet only a few of them describe some details of the oral features. The aim of this paper is to describe 2 cases of Noonan syndrome, emphasizing oral and facial aspects and particularities of the dental treatment in subjects affected by this genetic disease.

Acromegaly in an orthodontic patient

A 32-year-old white man presented for orthodontic treatment with the chief complaint of mandibular prognathism; he was later found to have acromegaly. General information about pituitary adenomas, specifically growth hormone adenomas, is given, and treatment options are discussed.

Cephalometric evaluation of maxillomandibular relationships in patients wearing complete dentures: a pilot study

The purpose of this study was to evaluate the changes in vertical and sagittal maxillomandibular relationship of the patients who had been wearing dentures for an extensive period. Fifteen edentulous patients (seven men and eight women; mean age 63.5 years) who had worn dentures for six to 16 years (mean 10 years) were selected for this study. New prostheses were fabricated by conventional methods, and the patients were evaluated cephalometrically before and after the new prosthesis. The results were compared by Wilcoxon signed rank test (P < .05). Results indicated that a prognathic mandible and a pseudo Class III relationship with a reduced occlusal vertical dimension became a normal Class I maxillomandibular relation when the new prosthesis was inserted. A better facial profile was achieved.

An enlarged sella turcica on cephalometric radiograph

A 28-year-old male presented to the Orthodontic clinic for correction of his anterior crossbite due to mandibular prognathism as a result of pituitary adenoma with acromegaly. A radiographic cephalometric analysis and clinical orthodontic examination were made. This article describes in detail the methods of correcting the magnification of cephalometric linear measurements in sellar dimensions (length, depth and width) from lateral and posteroanterior cephalograms. Cephalometric findings revealed that the sella enlarged in all its dimensions with a deepening of the floor in this acromegalic case. We discuss the radiographic diagnosis of an enlarged sella turcica in intrasellar tumours and also emphasise the dentist's important role in the initial diagnosis of pituitary adenoma cases.

Lymphatic Malformation of the Lingual Base and Oral Floor

BACKGROUND

Lymphatic malformation of the tongue and floor of the mouth is associated with chronic airway problems, recurrent infection, and functional issues related to speech, oral hygiene, and malocclusion. There are no accepted anatomic guidelines or treatment protocols.

METHODS

This retrospective review focused on anatomic extent, treatment, complications, and airway management in 31 patients with lymphatic malformation of the lingual base and oral floor.

RESULTS

Involved adjacent structures included the neck (77 percent), mandible (41 percent), face (42 percent), lips (10 percent), pharynx (45 percent), and larynx (26 percent). Fifty-eight percent of patients required tracheostomy during infancy; decannulation was possible in two-thirds of these patients. Management included resection alone (42 percent), resection and sclerotherapy (26 percent), resection and laser coagulation (16 percent), sclerotherapy and laser coagulation (16 percent), and resection and radiofrequency ablation (3 percent). Resection involved the neck (58 percent), floor of the mouth (52 percent), and tongue (42 percent); there were often multiple procedures. Aspiration was tried with little success in 10 percent of patients. Virtually all patients had residual abnormal lymphatic tissue. Complications and posttherapeutic problems included infection (81 percent), neural damage (27 percent), difficulty in speech (23 percent), feeding problems (10 percent), and seroma or hematoma (6 percent). Associated dental/orthognathic conditions, particularly prognathism and anterior open bite, were documented in one-third of patients.

CONCLUSIONS

The initial step in the protocol is control of the neonatal airway. Staged cervical resection is undertaken in late infancy to early childhood; resection should also include abnormal tissue in the oral floor. Sclerotherapy is primarily for macrocystic disease or secondarily for recurrent cysts following partial extirpation. Vesicles of the mucous membranes and dorsal tongue are treated either by sclerotherapy, laser (carbon dioxide, yttrium-aluminum-garnet, or potassium-titanyl-phosphate), or radiofrequency ablation. Reduction for macroglossia is indicated for persistent protrusion or to allow correction of malocclusion. Embolization controls lingual bleeding. Orthognathic procedures are undertaken at the appropriate age, only after lingual size and position are acceptable.

[82-year old patient with hyperostosis frontalis, prognathism, makroglossia and cutis gyrata. Acromegaly]

We present a 82 year old female patient with typical acral enlargement. There were no signs of visceromegaly. Magnetic resonance imaging of the pituitary region showed a macroadenoma. Oral glucose tolerance test revealed missing suppression of the Human Growth Hormone (HGH), which could be achieved with a long acting somatostatin analog. A HGH suppressive therapy with a long acting dopamine agonist (Cabergolin) was induced. The patient died one year later following cardiovascular complications.

Lip sucking and lip biting in the primary dentition: two cases treated with a morphological approach combined with lip exercises and habituation

Lip sucking and lip biting in the primary-dentition period can cause the upper incisors to tip labially and the lower incisors to collapse lingually with the lower lip wedged between the upper and lower anterior teeth. The resulting lip incompetence further aggravates maxillary protrusion. Thus, there is a causal relationship between lip sucking/lip biting and maxillary protrusion. Orofacial myologists provide lip training to activate the flaccid upper lip and raise the child's awareness to help stop the sucking or biting of the lower lip, sometimes using an oral screen. Two primary-dentition cases with lip sucking and lip biting were treated with a functional appliance (F.A.), resulting in the elimination of the habits in 5 to 6 months along with the improvement of the overjet, overbite and facial profile. The authors prioritize myofunctional therapy (MFT) when treating open bite cases with tongue thrust in the primary dentition. However, the treatment of maxillary protrusion due to lip sucking and lip biting is approached differently with priority given to morphological improvement to create an oral environment that makes lip sucking and lip biting difficult, which is complimented with lip exercises and habituation. This combined approach was found to be effective in breaking the lip-sucking and lip-biting habits.

[Seip Berardinelli: the effect of the partial tongue resection]

The Seip Berardinelli or undiagnosed endocrine metabolic syndrome is a rare autosomal recessive pathology mainly described in families of Portuguese origins. This syndrome presents various metabolic disturbances responsible of various dysmorphies. We report the case of two brothers seen during their childhood for respiratory, speaking and feeding problems related to a class 3 of Angle and macroglossia. The object was to study the interaction between the size of the tongue, the prognathism and the disturbances presented in order to organize early surgery (partial glossectomy).

Hajdu-Cheney syndrome (acro-osteolysis): a case report of dental interest

Hajdu-Cheney syndrome (acro-osteolysis) is a rare disorder of bone metabolism characterized by progressive lytic lesions in a number of bones. Constant features of this condition include an osteoporotic skeleton, acro-osteolysis, and a shortened lower third of face. The purpose of this report was to focus on the craniofacial and oral manifestations of the disorder in a 9-year-old boy.

A case of acromegaly

A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. Thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.

Gingival enlargement in acromegaly

In this study, we investigated gingival enlargement in patients with acromegaly as a component of the disease. Eleven patients (5 males, 6 females) were evaluated. Diagnosis was confirmed with typical clinical features and laboratory. Oral examinations were carried out by the same periodontist. During the examination, plaque index, gingival index, probing pocket depths, and gingival enlargement values were evaluated. Duration of the disease was between 0.2 and 13 yr. Seven patients had pituitary macroadenomas and four had microadenomas during their initial diagnosis. Only one patient was newly diagnosed. The other patients had previously undergone surgery. Gingival enlargement was found in eight patients. Seven patients with gingival enlargement also had prognathism, and one patient had prognathism associated with gingival enlargement. These findings demonstrate that acromegaly that results in overgrowth in various organs should be considered one of the causes of gingival enlargement.

Anthropometric finding in Nigerian children with sickle cell disease

PURPOSE

Sickle cell disease (SCD) subjects have been widely reported to present with various anthropometric deficits, including malocclusion and stunting, compared to their unaffected peers. This study was carried out to examine these reports in Lagos.

METHODS

A hospital-based cross-sectional study was carried out in 3 outpatient SCD units of one teaching and two general hospitals. All established SCD subjects aged 1 to 18 years (n = 177) were examined on consecutive clinic days. Controls (unaffected subjects; n = 122) were obtained from well-baby and surgical emergency clinics. Facial profile, occlusion, height, weight, head and mid-upper arm (MUA) circumference measurements were noted.

RESULTS

A prognathic maxillary profile was found to be more prevalent in SCD subjects (21%) than controls (4%; P < .05). Class II malocclusion was found in 21% of SCD subjects compared to 2% of controls (P < .05). The overall mean height, weight and head circumference of SCD subjects and controls were not significantly different (P > .05). However, at age 18 years, the weight of the SCD group was significantly less than that of the control group (P < .05). The mean MUA circumference was significantly higher in the control group (20.04 cm +/- 3.80) than in SCD subjects (17.91 cm +/- 2.96; P < .05).

CONCLUSIONS

There was a higher prevalence of maxillary protrusion. and Class II malocclusion in SCD subjects than controls. Height and weight were not significantly different in both groups except at 18 years when SCD subjects weighed less than controls.

Efficacy of high condylectomy for management of condylar hyperplasia

The purpose of this study was to compare the treatment outcome and long-term stability of 2 groups of young adult patients diagnosed with active condylar hyperplasia and treated with 2 different surgical methods. Thirty-seven patients (19 females and 18 males) met the criteria for inclusion in the study. Group 1 (n = 12; average age at surgery, 17.5 years) was treated with orthognathic surgery only, while group 2 (n = 25; average age at surgery, 16.7 years) had high condylectomy, articular disc repositioning, and orthognathic surgery. All patients underwent standardized clinical and radiographic examination at initial consultation, immediately before surgery, immediately after surgery, and at longest follow-up. Objective evaluation of temporomandibular joint (TMJ) function included maximum incisal opening and lateral excursions. Subjective evaluations were performed in group 2 for TMJ pain, jaw function, and diet. Lateral cephalometric radiographs were evaluated for presurgical and postsurgical mandibular growth. There were no statistically significant differences (P >.05) between the 2 groups for maximal incisal opening, lateral excursions, or subjective jaw function before surgery. Presurgical growth differed significantly (P <.05), with group 2 showing more active growth. At the long-term follow-up, no differences were found in lateral excursions or subjective jaw function. There was a statistically significant difference in maximum incisal opening (P <.01), with a greater increase in group 2, as well as a statistically significant difference (P <.05) in cephalometric stability, with group 2 being much more stable at long-term follow-up. All patients in group 1 grew back into skeletal and occlusal Class III relationships and required secondary intervention. Only 1 patient in group 2 required secondary surgery, involving maxillary surgery to correct postsurgical transverse maxillary relapse; the mandible was stable at long-term follow-up. The results of this study showed that patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery have stable, predictable outcomes compared with those treated with orthognathic surgery alone.

Oral and craniofacial findings in Fabry's disease: a report of 13 patients

OBJECTIVE

Fabry's disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme alpha-galactosidase A. The purpose of this study was to assess oral and craniofacial findings in a cohort of patients with Fabry's disease to facilitate recognition of this condition and early treatment of its manifestations.

STUDY DESIGN

This is a case series describing oral and craniofacial findings of 13 male patients diagnosed with Fabry's disease. Data were collected by means of a standardized questionnaire, clinical examination, panoramic and cephalometric radiographs, and magnetic resonance imaging.

RESULTS

A variety of abnormalities are described, including an increased prevalence of cysts/pseudocysts of the maxillary sinuses (PCMs) and the presence of maxillary prognathism.

CONCLUSION

Given the high prevalence of oral and dental abnormalities, we recommend a thorough stomatologic evaluation of these patients.

Pure ectodermal dysplasia: retrospective study of 16 cases and literature review

OBJECTIVE

To review the possible craniomaxillofacial deformative consequences associated with ectodermal dysplasias and embryonic malformations, which include dental ageneses.

SETTING

Oral and Maxillofacial Surgery Department, University Hospital, Lille, France.

PATIENTS

Sixteen patients (seven boys and nine girls, aged 4 to 34 years) with pure ectodermal dysplasia (no ectodermal dysplasia syndromes).

INTERVENTIONS

All patients had a clinical examination. Seven (two boys and five girls, aged 4 to 25 years) had undergone plaster casts and radiographic and Delaire's cephalometric studies before being treated.

MAIN OUTCOME MEASURES

All patients had tooth ageneses (from hypodontia to anodontia), associated with cutaneous dyshidrosis and hair and nail dystrophy. Most of them had a short face, with an unusual facial concavity, a maxillary retrusion, and a relative mandibular protrusion. MANAGEMENT RESULTS AND DISCUSSION: Depending on their ages and their orthopedic abnormalities, patients underwent either dental or prosthodontic, orthodontic, orthopedic, orthognathic, or implant treatment. So as not to interfere with the growth pattern, we preferred to reserve implant and orthognathic surgery for full-grown cases.

CONCLUSIONS

Oral and maxillofacial surgeons must undertake a comprehensive approach to these patients to improve their dental, masticatory, growing, and orthognathic conditions.

Ellis-van Creveld syndrome: dental, clinical, genetic and dermatoglyphic findings of a case

Dental, clinical, genetic and dermatoglyphic findings of an additional female case with Ellis-van Creveld syndrome (EVC) are presented and compared with those of the cases cited in the literature. The dermatoglyphics of the case was remarkable.

Familial choanal atresia with maxillary hypoplasia, prognathism, and hypodontia

We report on two sibs and a cousin with bilateral choanal atresia. At 2 months, one sib died of complications following surgical correction of her defects. We evaluated her brother and cousin at age 7 and 9 years, respectively. Both had a tall forehead, maxillary hypoplasia, prognathism, and absence of certain deciduous and permanent teeth. Psychomotor development was appropriate for age. Roentgenocephalometric analyses of several relatives showed that one grandfather of these children and two of the five uncles and aunts also had maxillary hypoplasia and/or prognathism. To our knowledge, this condition has not been described previously and may represent a newly recognized autosomal dominant condition with incomplete penetrance and variable expressivity caused by a defect of neural crest development.

[Pseudoprognathism frequency and masseter muscle activity in operated cleft lip patients]

BACKGROUND

As a consequence of a growth inhibition of middle third of the face, cleft lip surgery could lead to a pseudoprognathism. However, this is not always the case. Also, when facial architecture is changed, the activity of muscles such as the masseter could be disturbed.

AIM

To study masseter electromyographic activity in operated cleft lip patients.

MATERIAL AND METHODS

Forty two patients with cleft lip (25 male, aged 13 to 35 years old) were studied. All were operated during their first year of life. An electromyography of masseter muscle was performed and from a teleradiography, ANB and Gonion angles were obtained. Forty healthy subjects conformed the control group.

RESULTS

The sample was divided in two groups. A group of 20 patients had a significantly lower EMG voltage than control subjects (662 +/- 228 and 1511 +/- 340 microV respectively, p < 0.001). Only seven patients had an anteriorly inverted bite with a mean ANB of + 1.7 and a mean molar relation of -4.8, figures that confirm the presence of pseudoprognathism.

CONCLUSIONS

Eighty three percent of cleft lip patients do not have cephalometric parameters of pseudoprognathism and half of the patients have a lower masseter activity.

Temporomandibular joint reconstruction in children using costochondral grafts

PURPOSE

The aim of this study was to evaluate the postoperative growth of the mandible after reconstruction of the condylar process using costochondral grafts in children.

PATIENTS AND METHODS

Temporomandibular joint (TMJ) ankylosis was surgically treated and the joint reconstructed with a costochondral graft (CCG) in two boys and eight girls with a mean age of 7.4 years. Two children had bilateral ankylosis. Postoperative changes and craniofacial growth were monitored by lateral and posteroanterior (PA) cephalograms annually from 2 to 6 years (mean of 4 years).

RESULTS

Postoperatively, in the eight children with unilateral TMJ reconstruction, the mandible (Co-Gn) grew an average of 14.7 mm in length on the affected side and 15.1 mm on the nonaffected side; ramus length (Co-Go) increased an average of 7.1 mm on the affected side and 7.3 mm on the nonaffected side. However, in five of the children the chin progressively deviated toward the nonaffected side after TMJ reconstruction. The CCGs tended to have a more vertically directed condylar growth pattern and a more laterally positioned condyle. In the two cases with bilateral TMJ reconstruction, the CCGs grew until there was a mandibular prognathism that required orthognathic surgery to set back the mandible.

CONCLUSIONS

Using CCGs to reconstruct TMJ ankylosis in children provides a functional condyle with growth potential. However, there is a possibility of excessive growth of the graft, resulting in deviation of the chin and mandibular prognathism years later.

Upper dental arch morphology of adult unoperated complete bilateral cleft lip and palate

Literature has shown that, even with the conservative nontraumatic surgical techniques, early repairing surgeries induce changes in the upper dental arch morphologic characteristics in patients with cleft lip and palate. The evaluation of unoperated adult cleft patients enables us to exclude the influence of treatment, emphasizing the morphologic characteristics inherent to the presence of the cleft and its functional counterbalances, that is, the morphologic pattern imposed by cleft. In this study, the maxillary dental casts of 31 unoperated adult complete bilateral cleft lip and palate patients (20 men and 11 women) were compared to a noncleft sample matched for gender. Intercanine, inter-first premolar, inter-second premolar and inter-first molar arch widths measurements as well as arch length were measured from xerox copies taken of the models. The findings indicate the presence of premaxillary prognathism and a progressive increase in the constriction of the dental arches. This constriction of the maxillary segments, even in the absence of surgical intervention, is a result of the absence of an intact palate between the two maxillary processes. Although gender significantly influenced the size of the maxillary arches in the noncleft patients, similar differences were not observed in the cleft group. It seems that the presence of the cleft in itself has the greater influence on the morphologic characteristics of the maxillary arch than gender.

Characteristics of jaw growth in cleidocranial dysplasia

OBJECTIVE

The purpose of this pilot study was to assess craniofacial morphology in young and adult individuals with cleidocranial dysplasia (CCD).

DESIGN

Craniofacial morphology in young individuals (primary dentition) and in young adults was compared with control data using ratios and angles obtained from lateral head films.

SETTING

The CCD individuals were referred to the Center for Craniofacial Anomalies for diagnostic workup and treatment recommendations.

SUBJECTS

The sample consisted of 14 Caucasians. The inclusion criterion for the young, prepubertal group (A) was complete primary dentition, and for the adult, postpubertal group (B), the eruption of all four first molars was required.

INTERVENTIONS

No treatment other than extraction or surgical removal of selected primary or supernumerary teeth was performed.

RESULTS

Both groups showed significantly smaller anterior upper face height compared with controls. Group B subjects demonstrated significantly smaller face height values than the controls in the A point-nasion-B point (ANB) angle, facial axis, mandibular plane angle, palatal plane/mandibular plane angle, and gonial angle. No significant differences were found between group A individuals and the controls for these measurements. The older group had shorter anterior lower face height compared with both anterior upper face height and posterior lower face height.

CONCLUSIONS

Whereas young CCD subjects showed relatively normal jaw proportions and morphology of the mandible, older CCD individuals tended to have short lower face height, acute gonial angle, anterior inclination of the mandible, and mandibular prognathism. These differences can be attributed to pronounced horizontal mandibular growth resulting from lack of vertical maxillary growth and impaired eruption of permanent teeth.

Acromegaly identified in a patient with a complaint of malocclusion

Acromegaly in a female patient was first diagnosed after a dental examination at which time the patient complained of the inability to incise properly. An elevated serum growth hormone level and enlarged sella turcica confirmed the diagnosis of acromegaly. Based on examination of her plaster study models, it was apparent the patient had been developing a change in her dentition for years.

Thin-plate spline analysis of the cranial base in subjects with Class III malocclusion

The role of the cranial base in the emergence of Class III malocclusion is not fully understood. This study determines deformations that contribute to a Class III cranial base morphology, employing thin-plate spline analysis on lateral cephalographs. A total of 73 children of European-American descent aged between 5 and 11 years of age with Class III malocclusion were compared with an equivalent group of subjects with a normal, untreated, Class I molar occlusion. The cephalographs were traced, checked and subdivided into seven age- and sex-matched groups. Thirteen points on the cranial base were identified and digitized. The datasets were scaled to an equivalent size, and statistical analysis indicated significant differences between average Class I and Class III cranial base morphologies for each group. Thin-plate spline analysis indicated that both affine (uniform) and non-affine transformations contribute toward the total spline for each average cranial base morphology at each age group analysed. For non-affine transformations, Partial warps 10, 8 and 7 had high magnitudes, indicating large-scale deformations affecting Bolton point, basion, pterygo-maxillare, Ricketts' point and articulare. In contrast, high eigenvalues associated with Partial warps 1-3, indicating localized shape changes, were found at tuberculum sellae, sella, and the frontonasomaxillary suture. It is concluded that large spatial-scale deformations affect the occipital complex of the cranial base and sphenoidal region, in combination with localized distortions at the frontonasal suture. These deformations may contribute to reduced orthocephalization or deficient flattening of the cranial base antero-posteriorly that, in turn, leads to the formation of a Class III malocclusion.

[Use of an overdenture in the prosthetic correction in a patient with cleft palate]

A fourty-year old male patient with cleft palate had been operated on four times in his childhood in order to close the defect. The shrinked dental arch and the pseudoprogenia, remaining after the operation, caused problems in the mastication and esthetic defects to the patient. With the help of an overdenture a new dental arch was created, in this way the pseudoprogenia could be eliminated, the facial harmony and the mastication could be restored.

Tongue volume in human female adults with mandibular prognathism

It has often been hypothesized that a large tongue leads to an enlargement of the mandible and therefore contributes to the development of mandibular prognathism. We examined (1) whether the tongue volume in human subjects with mandibular prognathism was larger than that in subjects with good occlusion and (2) whether the tongue volume and the pharyngeal capacity correlated with the morphological characteristics of dento-skeletal structures. Magnetic resonance images of the tongue and its surrounding structures were recorded for female adult volunteers with good occlusion (control group, n = 10) and patients with mandibular prognathism (test group, n = 16). Lateral cephalograms were obtained for the patients. No significant differences were determined for the tongue volume or the pharyngeal capacity between the two groups. The tongue volume did not correlate with the pharyngeal capacity (r = 0.280, p = 0.166). The tongue volume correlated with the facial angle (r = 0.548, p = 0.028), the Y-axis (r = 0.539, p = 0.031), and the angle nasion-A point-pogonion (r = 0.540, p = 0.031). These results suggest that the tongue volume is accounted for by the combined horizontal and vertical location of the chin and symphysis, but do not support the conventional clinical surmise that large tongue volume is inherent in patients with mandibular prognathism.

Surgical correction of facial deformities in a patient with cleidocranial dysplasia

A one-stage procedure for correction of the maxillofacial skeletal deformities associated with cleidocranial dysplasia is presented. The common bony abnormalities are discussed, and the combined surgical and orthodontic management over an 8-year period is outlined.

Facial and dental anomalies in cleidocranial dysplasia: a study of 17 cases

Seventeen cases of cleidocranial dysplasia were analysed. On average, there was mandibular prognathism due to increased mandibular length, and a short cranial base. The maxilla was short vertically but not antero-posteriorly. In 13 young subjects followed for an average period of 6 years, more than half of the total number of teeth of each type had not erupted at the normal age, with the exception of mandibular incisors. Twice as many maxillary incisors were delayed compared with those in the lower jaw. Only six of 25 mandibular central incisors were delayed. There was a total of 63 supernumerary teeth in the 13 subjects, mostly occurring in the mandibular premolar and maxillary incisor regions. Many more occurred in the maxillary than in the mandibular incisor region. In the molar regions only six supernumerary teeth were found, five in the upper jaw and one in the lower. Two patients had no supernumerary teeth. One patient showed congenital absence of one mandibular incisor and three premolars.

Natural cervical inclination and craniofacial structure

The purpose of this study was to search for the statistical associations between postural and morphologic variables of the head. Interpretation of the facial structure was made by using both intracranial and the extracranial reference lines. The sample comprised natural head posture (NHP) cephalograms of 106 dental students, aged 19 to 29 years. Results showed that, when the facial structure was evaluated by using a NHP analysis based on extracranial reference lines, it was associated with the inclination of the cervical column to the true horizontal. In addition, in the natural position of the head, inclination of the NSL reference was found to be associated with the vertical localization of sella turcica (r = -724, p < or = 0.001), rather than the "extension" or "flexion" of the head. It was concluded that associations between posture and structure of the head are merely caused by the functional factors related to "forward cervical posture" and "vertical cervical posture".

Cause of early skeletal relapse after mandibular setback

The present study was undertaken to examine the factors that might be responsible for the skeletal relapse occurring during the period of intermaxillary fixation after mandibular setback osteotomy. Fifteen patients, treated for absolute mandibular prognathism by modified sagittal split ramus osteotomy and fixation by skeletal suspension wiring, were evaluated cephalometrically by reference to the degree of postsurgical superior shift of the gonial region of the distal segment as a parameter of relapse since such a shift was evident despite the use of wiring. It was found that the degree of inadvertent anteroposterior rotation of the proximal segment at surgery, rather than the extent and pattern of surgical repositioning of the distal segment, was significantly correlated with the degree of shift. This result emphasizes the justification of preserving the proximal segment in its exact original anatomic site, in addition to the use of skeletal fixation, to ensure predictable stability after mandibular setback osteotomy.

Cranial base and jaw relationship

The lateral skull radiographs of 124 boys aged approximately 10 years divided equally between the four angle classes were digitized in an effort to establish the relationship between cranial base size and shape and jaw relationship. Comparison of the means for occlusal groups showed a trend from class II to class III as cranial base dimensions and angle decreased. The condyle was also more distally positioned with respect to nasion, point A and the Pterygomaxillary vertical in the class II groups. Cranial base length correlated strongly with maxillary length but weakly with mandibular length. Nevertheless, the size of the maxilla did not influence its prognathism. The cranial base angle was strongly correlated (-0.7) with angle sella-nasion-point B. It is concluded that cranial base size and shape influence mandibular prognathism by determining the anteroposterior position of the condyle relative to the facial profile.

Surgical correction of mandibulofacial deformities secondary to large cervical cystic hygromas

The clinical features of cystic hygroma are presented. The effect on mandibular morphology is described, and surgical correction of the deformities is discussed.

Genetic and environmental factors in the development of so-called pseudo- and true mesiocclusions

Separation of genetic and environmental factors related to the development of so-called pseudo- and true mesioclusions was attempted and the classification, which is in common use in clinical orthodontics, reconsidered. A differential diagnosis of these two types of mesioclusions was made depending on whether or not the mandible slid forward into displacement by incisal guidance. By means of lateral roentgenographic cephalograms obtained from 66 pseudo- and 48 true mesioclusion patients and 52 control subjects, and their respective parents, the craniofacial morphogenetic characteristics of each mesioclusion were determined. A familial tendency to prognathic skeletal profile was noted in cases of both pseudo- and true mesioclusions. Nearly all of the significant morphogenetic differences between the two groups of patients with mesioclusion were related to environmental factors. The terms "pseudo" and "true" are probably misleading expressions for these mesioclusions.