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The objective of this study was to change procedures in our medical center regarding frenotomy for ankyloglossia (tongue-tie). The medical and breastfeeding outcomes of 36 fullterm infants who received frenotomies were studied. The information was used to develop frenotomy eligibility standards that would guide other physicians and insure timely treatment to avoid breastfeeding cessation.
Recent advances in endoscopic surgery have developed an endonasal route suitable for pituitary surgery. The main goal of this article is to evaluate benefits of our endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors in 215 consecutive cases. The pathological classifications of the 215 cases are as follows: 163 pituitary adenomas, 23 Rathke's cleft cysts, 17 craniopharyngiomas, and 12 others. The patients were surgically treated via the endonasal trans-sphenoidal approach using an operating microscope as the primary instrument for tumor resection. Endoscopes were used to complement the operating microscope in visualization. We compared the new approach to the sublabial trans-sphenoidal approach (197 cases) with respect to endocrinological outcomes and surgical complications. Our endonasal trans-sphenoidal approach was beneficial in eliminating the complications of lip numbness, which was often observed in patients undergoing sublabial surgery, and nasal septal perforation. In addition, endocrinological outcome comparable to those in the sublabial group was achieved in the endonasal group. We consider that the endoscope, which allows visualization of areas not seen with the operating microscope, should be used actively in conjunction with the operating microscope that provides three-dimensional visualization and is timesaving. Our surgical method for pituitary tumors provides good results with minimal invasion, by exploiting the advantages of a microscope and an endoscope.
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The nose relates intimately to the upper lip. As in all facial cosmetic surgery, anatomic and aesthetic diagnosis of the deformity is essential to providing the best treatment possible in a particular patient. Within a reasonable range, changes may be made easily in the columella-labial area. Often these changes enhance the results of typical rhinoplastic maneuvers and make safer and more predictable the results of the rest of the rhinoplastic surgery. Techniques for altering the columella-labial region are presented. Examples are shown demonstrating diagnostic, aesthetic, and therapeutic aspects.
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Gingival recession affects a large proportion of the adult population. This paper discusses the aetiology and mechanisms behind the formation of gingival recession, and considers the relevance of gingival recession to both orthodontics and restorative dentistry. It is followed by a second paper on the management of gingival recession.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Maxillary midline diastemas are a common esthetic problem that dentists must treat. Many innovative therapies have been used, varying from restorative procedures to surgery (frenectomies) and orthodontics. At times, these procedures have been performed by the dentist without full appreciation of the factors contributing to the diastemas. CASE DESCRIPTION: Before the practitioner can determine the optimal treatment, he or she must consider the contributing factors. These include normal growth and development, tooth-size discrepancies, excessive incisor vertical overlap of different causes, mesiodistal and labiolingual incisor angulation, generalized spacing and pathological conditions. A carefully developed differential diagnosis allows the practitioner to choose the most effective orthodontic and/or restorative treatment. CLINICAL IMPLICATIONS: The differential diagnosis leads to a treatment approach that most effectively addresses the patient's problem. By treating the cause of the diastema, rather than just the space, the dentist enhances both the patient's dental function and appearance.
The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.
Six cases of a peculiar type of upper lip malformation have been observed by the author during the last 40 years. The malformations in this case series were remarkably similar, suggesting a single teratologic entity not been reported before. The six patients included 1-, 11-, 4-, and 6-month-old males, a 20 year-old male, and an 11-year-old female. Each was characterized by a crooked folded philtrum, a flat thin vermilion region of the upper lip, and high-positioned ala(e), that was unilateral or bilateral. The upper median incisors were separated occasionally by the thick lip frenulum without marked distortion of the nasomaxillary framework. The author speculates that these cases exhibited some disturbed penetration of the lateral nasal eminence (process) to the median part of the nasolabial region in their early embryologic development.
A case report of a congenital midline sinus of the upper lip in a 5-year-old girl is presented. The patient complained of intermittent swelling around the frenulum of the upper lip. The sinus was located on the midline of the philtrum just below the base of the columella. Excision of the sinus tract via an intraoral approach gave a satisfactory result. Microscopic examination of the resected sinus revealed it to be lined by stratified squamous epithelium with sebaceous glands and hair follicles. Fifteen other cases have been reported in the English literature and are reviewed. There are two postulates that can account for the formation of the upper lip sinus based on two major theories of the development of the face: the fusion theory and the merging theory. However, the etiology of this rare congenital sinus remains obscure.
OBJECTIVE: To describe a method of determining the three-dimensional topology of the palatal crest relative to a reproducible anthropomorphic coordinate system in newborn infants with unilateral cleft palate. For this purpose, physical models of the maxilla and face were analyzed by computer morphometry. DESIGN: The study was limited to infants referred to the craniofacial center during the first 11 days after birth. SETTING: The study was performed at a craniofacial center servicing a large geographic area. PARTICIPANTS: The method was applied to 12 infants with unilateral cleft lip, alveolus, and palate (eight patients with left-side clefts and four with right-side clefts). MAIN OUTCOME MEASURES: The three-dimensional topology of the palatal crest referenced to an anthropometric coordinate system was the primary outcome measure. The anthropometric reference system is defined by the tragus points and the midpoint of a line connecting the endocanthia. RESULTS: The topology of the maxillary crests of the patients was characterized by considerable variability. The center of the premaxilla as defined by the attachment of the frenulum was frequently displaced by several millimeters from the midsagittal plane. The displacement was to the left in infants with right-side clefts and to the right in infants with left-side clefts. The premaxilla can be rotated by more than 30 degrees relative to the normal position. No significant retroposition of the minor segment as determined by the location of the tuber points was found. Several morphometric anomalies were found to be correlated linearly. CONCLUSIONS: We propose that the morphologic deviations are in part caused by the neuromotor activity of the tongue and of the interrupted M. orbicularis oris. The data can serve as the starting point for a longitudinal study of craniofacial development in children with cleft palate and for studies on the efficacy of different therapeutic approaches.
OBJECTIVE: We present three new cases of congenital upper lip fistula. Two of them were located in the philtrum midline, one of which was associated to a double maxillary frenulum, a medial lip cleft, and a medial cleft of the primitive palate. The other was located in the left side of the vermilion. All three patients had clear fluid discharge through the fistulous orifice without pain. Two of them had a history of recurrent swelling of the philtrum area. CONCLUSIONS: A simple surgical excision is the treatment of choice in these cases, in which the anatomy is preserved; this fact is more consistent with a completed but aberrant development than with focal dysgenesis.
The appearance and cytodifferentiation of the Merkel cell were studied electron microscopically using the developing labial ridges of Rana japonica. The most primitive Merkel cell was identified with specific cored granules with an average diameter of about 90 nm. Such a primitive Merkel cell was found in the basal layer of the primitive labial ridge epithelium. As the primitive labial ridge continued to mature, the primitive Merkel cell accumulated an increased number of the specific granules, developed digital shaped cytoplasmic processes and came into contact with nerve fibers. When the labial ridge was sufficiently developed the cell showed typical morphological features of the mature Merkel cell except for a small accumulation of tonofilament-like structures and glycogen particles. It was also observed that the position of the Merkel cell in the epithelium changed from the basel layer to the third basal layer during development. On the other hand, it was difficult to find the Merkel cell in the mesenchymal layer of the developing labial ridges. From the results, it was suggested that the cytodifferentiation of the Merkel cell in the labial ridge of an anuran tadpole occurs within the epithelium.