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At least 343 records · Page 19Linked to original sources
PubMed1996

Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases.

PURPOSE: The purpose of this report is to show the feasibility and potential advantages of using internal devices for distraction osteogenesis in the management of maxillofacial skeletal deficiencies. PATIENTS AND METHODS: Distraction osteogenesis was used to correct a variety of maxillofacial skeletal deformities in five patients. One patient underwent bilateral Le Fort III advancement aided by distraction, three patients underwent mandibular ramus lengthening, and one patient underwent segmental alveolar reconstruction by distraction. The devices were activated by either a transcutaneous or transmucosal pin. After achievement of the desired skeletal transport, the activating pins were disengaged and removed from the distraction device. This allowed the distraction device to remain submerged and to stabilize the site of the consolidating bone. RESULTS: All patients achieved lengthening of their jaws. However, premature consolidation was noted in two patients, and one patient had significant relapse. CONCLUSIONS: Development of internal distraction devices is important to address the limitations of currently available biphasic systems. Potential benefits of internal devices include 1) elimination of skin scarring caused by translation of transcutaneous fixation pins, 2) improved patient compliance during the fixation or consolidation phase because there is no external component, and 3) improved stability of the attachment of the device to the bone.

Acrocephalosyndactylia↗
PubMed1999

Osseous remodeling after inferior border osteotomy for chin augmentation: an indication for early surgery.

PURPOSE: This study investigated the relationship of age at surgery and type of fixation to the pattern and extent of bone remodeling associated with inferior border osteotomy for chin augmentation. PATIENTS AND METHODS: Four groups of patients with similar chin advancement were established by age at the time of surgery: younger than 15, 15 to 19, 20 to 24, and older than 39 years. Cephalometric radiographs for immediate preoperative, immediate postoperative, and at least 9 months postoperative times were traced, digitized, and superimposed. RESULTS: The pattern of osseous remodeling was similar for all age-groups. This consisted of resorption of the superior-buccal aspect of the distal segment, bone apposition on the buccal surface of the proximal segment, and modest resorption at pogonion (mean change, 1 mm or less). There was no significant difference in stability of the chin advancement between wire and rigid (screw) fixation. There was a marked difference in the symphysis thickness regeneration of the youngest group (92% of the original symphysis thickness) compared with the rest of the groups (< or =66%, P < .001). CONCLUSIONS: Minimal remodeling at pogonion occurs in all age-groups with both wire and rigid fixation. Regeneration of symphysis thickness is much more complete in patients younger than 15 years at the time of surgery. This is potentially important for early treatment of severe chin deficiency, because it permits additional advancement of the chin later in life, if necessary.

Adolescent↗
PubMed1975

Vertical osteotomy of the ascending rami in mandibular retrognathism.

The authors present their experience and conclusions regarding surgical lengthening of the mandible in retrognathism due to bone hypo-development. Thus, in hypotrophies of the ascending ramus, especially in temporo-mandibular ankylosis, they use a longitudinal osteotomy (Popescu 1949); various technical adaptations of this method, in different situations, are described, as well as their association with osteoplasty, utilizing iliac bone grafts or the hypertrophic chin prominence. In retrognathism due to hypo-development of the mandible, when the ascending rami have a good conformation, sagittal osteotomy (Obwegeser 1957, Dal Pont 1961) is preferred.

Ankylosis↗
PubMed2002

A review of the anatomy of the upper airway in early infancy and its possible relevance to SIDS.

BACKGROUND: Since the danger of prone sleeping in the first 6 months of life has been publicised, there has been a dramatic and consistent reduction in the incidence of sudden infant death syndrome (SIDS). However, unexpected infant deaths and apparent life-threatening events (ALTEs) continue to occur that are clearly not associated with known epidemiological risk factors. AIMS: To review the unique features of the anatomy and function of the upper airway of the young infant which contribute to increased vulnerability to hypoxia in this age group. We discuss the clinical identification of those infants at risk of obstruction or restriction of the upper airway and the management of the 'at risk' infant. CONCLUSIONS: In the era after the "back to sleep" campaigns, it is likely that an increasing proportion of cases of ALTEs and SIDS will be related to obstruction or limitation of upper airway size leading to sleep hypoxia/asphyxia. This type of problem may be anticipated by evaluation and investigation of infants with signs or a clinical history consistent with possible upper respiratory tract compromise, including micrognathia.

Humans↗
PubMed1993

Natural coral skeleton used as onlay graft for contour augmentation of the face. A preliminary report.

The skeletons of two different genera of Madreporaria were used as onlay graft material for contour augmentation of the face. With coral blocks or granules in a subperiosteal fashion, patients with hemifacial microsomia, maxillary hypoplasia, microgenia, and Treacher Collins' syndrome have been adequately treated. Sixteen augmentations were performed in 14 patients, followed up for 6-34 months. One graft had to be removed because its inadequate fixation resulted in mobility. Delayed healing was observed in another case for the same reason. Coral skeleton is a cheap, natural biomaterial with excellent biocompatibility. It can easily be prepared and shaped, and it maintained its form over the period observed.

Adolescent↗
PubMed2002

[Andersen syndrome, ventricular arrhythmias and channelopathy (a case report)].

INTRODUCTION: Recent advances in molecular genetic research have provided new insights into severe ventricular arrhythmias related to channelopathies. CASE REPORT: A case of Andersen's syndrome followed during fourteen years is reported. This rare familial periodic paralysis is characterized by its association with dysmorphic features (micrognatia) and ventricular arrhythmias. COMMENTS: Andersen's syndrome has been attributed to a mutation in the KCNJ2 gene which is involved not only in stabilizing cardiac rhythm, but also in modulating the excitability of skeletal muscle and in morphogenesis. This disease must be distinguished from hyperkalemic periodic paralysis due to a mutation in the skeletal muscle sodium channel gene (SCN4A) and from hypokalemic periodic paralysis related to dihydropyridine receptor mutation (CACNL1A3). Furthermore, it may not be confused with others rhythmic channelopathies (long QT syndromes, catecholaminergic polymorphic ventricular tachycardia and Brugada's syndrome).

Adolescent↗
PubMed2000

Anesthetic management for patients with arthrogryposis multiplex congenita and severe micrognathia: case reports.

Arthrogryposis multiplex congenita (AMC) is a spectrum syndrome of multiple persistent limb contractures often accompanied by associated anomalies, including cleft palate, genitourinary defects, gastroschisis, and cardiac defects. Pediatric patients with AMC frequently present for multiple surgeries requiring general endotracheal anesthesia. We describe our anesthetic experience with the laryngeal mask airway and endotracheal tube in two neonates with AMC and severe micrognathia. We discuss AMC and outline the problems encountered in difficult airway management.

Anesthesia↗
PubMed1999

Cervical plexus block in adolescents.

In adults, peripheral nerve block provides an effective alternative to general anesthesia. In pediatric anesthesia practice, several factors may limit the use of such techniques. I present two adolescents in whom anatomical alterations precluded routine airway management. Cervical plexus block was used to provide surgical anesthesia for superficial/deep lymph node biopsy and excision of a thyroid nodule. The technique for cervical plexus block and its possible application in the practice of pediatric anesthesia are reviewed.

Adolescent↗
PubMed1995

Pathogenesis of bromodeoxyuridine-induced cleft palate in mice.

This study was designed to examine the pathogenesis of bromodeoxyuridine-induced (BrdU) clefts of the secondary palate in mice. Intraperitoneal injections of BrdU (500 mg/kg body weight) were given on days 11 and 12 to some pregnant mice and on days 12 and 13, and days 11, 12 and 13 to others. Evaluation of craniofacial relations and palate development in BrdU-treated mice revealed inhibition of vertical development of the palatal shelves, mandibular hypoplasia which led to failure of downward displacement of the tongue and the creation of an obstacle to reorientation of the palatal shelves. The results of this study demonstrate a strong correlation between induction of cleft palate and the presence of structural alterations in the mandible, and the mechanism of BrdU-induced cleft palate resembles the defect in the Pierre Robin anomaly.

Abnormalities, Drug-Induced↗
PubMed1999

Distraction osteogenesis of the mandible: a ten-year experience.

Mandibular distraction has been performed at the authors' institution for the past 10 years on a variety of craniofacial anomalies. This article reviews the experience with distraction and outlines the authors' treatment algorithms based on patient age and pathology. The roles of distraction versus conventional orthognathic surgery are reviewed. The need for preoperative surgical planning and postoperative orthodontic therapy is emphasized.

Adolescent↗
PubMed1999

Treatment planning and biomechanics of distraction osteogenesis from an orthodontic perspective.

As in traditional combined surgical and orthodontic procedures, the orthodontist has a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning both the predistraction and postdistraction orthodontic care. Based on careful clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and evaluation of three-dimensional computed tomographic scans, the orthodontist, in collaboration with the surgeon, plans distraction device placement and the predicted vectors of distraction. Both surgeon and orthodontist closely monitor the patient during the active distraction phase, using intermaxillary elastic traction, sometimes combined with guide planes, bite plates, and stabilization arches, to mold the newly formed bone (regenerate) while optimizing the developing occlusion. Postdistraction change caused by relapse is minimal. Growth after mandibular distraction is variable and appears to be dependent on the genetic program of the native bone and the surrounding soft tissue matrix. A significant advantage of distraction osteogenesis is the gradual lengthening of the soft tissues and surrounding functional spaces. Distraction osteogenesis can be applied at an earlier age than traditional orthognathic surgery because the technique is relatively simple and bone grafts are not required for augmentation of the hypoplastic craniofacial skeleton. In this new technique, the surgeon and the orthodontist have become collaborators in a process that gradually alters the magnitude and direction of craniofacial growth.

Biomechanical Phenomena↗