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At least 379 records · Page 21Linked to original sources
PubMed2002

Soft tissue healing after parasagittal palatal incisions in segmental maxillary surgery: a review of 311 patients.

PURPOSE: This study retrospectively evaluated the soft tissue healing after using parasagittal soft tissue incisions for surgical segmental maxillary expansion. PATIENTS AND METHODS: The records of 311 patients (224 females, 87 males), with an average age of 28.5 years (range, 12 to 62 years) who had transverse maxillary hypoplasia, were retrospectively evaluated. All patients underwent segmental maxillary osteotomies, surgical maxillary expansion greater than 5 mm, and placement of midpalatal porous block hydroxyapatite (PBHA). Parasagittal palatal soft tissue incisions were used to facilitate expansion, minimize soft tissue damage, and maintain soft tissue coverage over the PBHA implants. At postoperative follow-up visits, any signs or symptoms of complications associated with the use of the parasagittal incisions were recorded. RESULTS: Average patient follow-up was 3.4 years (range, 1.0 to 7.2 years). In 293 patients (94%), the palates healed uneventfully without complications. Eighteen patients (6%) had complications; 9 (2.9%) had infections associated with the midpalatal implants, 8 (2.6%) had oronasal communications, and 1 (0.3%) had problems associated with a palatal wire. Six patients with midpalatal implant problems required removal of the implant, 4 patients required closure of their oronasal communications, and 1 patient required removal of a palatal wire. Therefore, 11 patients (3.5%) required minor secondary surgical procedures. No teeth or alveolar bone were lost in any of the cases. CONCLUSIONS: The use of parasagittal palatal incisions appears to be a safe technique for soft tissue management during large surgical maxillary expansions associated with segmental maxillary osteotomies and midpalatal placement of PBHA implants.

Adolescent↗
PubMed2002

Effects of sutural distraction osteogenesis applied to rat maxillary complex on craniofacial growth.

PURPOSE: This study was designed to investigate the effects of artificial mechanical separation of the circummaxillary sutures on craniofacial growth in growing rats. MATERIALS AND METHODS: Twenty 4-week-old Wistar strain male rats were divided equally into experimental and control groups. In the experimental group, 4 holes were made on the maxillary and temporary bones, and expansion appliances were placed into the holes for sutural separation bilaterally. The operated control group underwent sham surgery only. Lateral and dorsoventral cephalograms were taken of the animals every 2 weeks from age 4 to 12 weeks. Linear and angular measurements on the lateral cephalograms were analyzed and subjected to statistical treatment with Student's t-test. All animals were killed for histologic examination 8 weeks after the initiation of the experiment. RESULTS: Nasomaxillary growth and the forward displacement were significantly larger in the experimental group than in the controls (P <.01). New bone formation was clearly observed in the (mechanically separated) sutural space in association with normal healing of the sutural structures. CONCLUSIONS: These findings show that mechanical separation of the circummaxillary sutures, as a new orthopedic approach, accelerated nasomaxillary growth, in this experimental model.

Analysis of Variance↗
PubMed2003

Theoretical considerations for the surgical correction of mandibular deformity in hemifacial microsomia patients using multifocal distraction osteogenesis.

PURPOSE: This theoretical pilot study investigated the geometric changes necessary to normalize the mandibular shape in hemifacial microsomia. Using the mandibular deformity of a 13-year-old patient affected by hemifacial microsomia as an example, we addressed 2 main issues. First, the number of segments needed for adequate reshaping of the deformed mandible is evaluated. Second, the geometry of the intersegmental gaps resulting from reposition of the segments is correlated with established parameters of distraction osteogenesis to theoretically predict the practicability of correction using multifocal distraction osteogenesis. MATERIALS AND METHODS: Virtual surgery was performed on a solid mandible model created from computed tomography (CT) data from a patient with hemifacial microsomia type IIB. In the first step, ideal mandibular reshaping was achieved according to anthropometric standard measurements using 7 osteotomies. By scanning and superimposition of the virtual models and variation of distraction sites and numbers, we assessed the minimal number of osteotomies necessary for optimal correction of the deformity. Geometrical evaluation of the regeneration and assessment of the possibilities of continuous curved distraction were also performed. RESULTS: Three osteotomies were shown to be sufficient for complete mandibular reshaping. Using accepted parameters for distraction osteogenesis, the geometry of the regenerate allows for continuous curved distraction. However, simultaneous movements at several distraction sites result in interfering vector forces, making coordination of multifocal distraction difficult. CONCLUSION: Theoretical assessment of a severe mandibular hypoplasia in hemifacial microsomia revealed the 3-dimensional (3D) complexity of the deformity for corrective procedures, especially distraction osteogenesis. Despite precise planning and transfer of the plan to the patient, multifocal 3D distraction may result in deviations from the planned result. Manipulation of the fresh regeneration may be necessary to correct inaccuracies.

Adolescent↗
PubMed2002

Extensor-tendon hypoplasia and multiple pterygia: Escobar syndrome in a 7-year-old boy.

Escobar syndrome is a rare condition with autosomal-recessive inheritance, characterised by multiple pterygia, kyphoscoliosis, multiple joint contractures and craniofacial dysmorphisms. A number of other abnormalities are also attributed to the syndrome. Here, we present a case of isolated extrinsic extensor-tendon hypoplasia of the right index finger in a 7-year-old patient with Escobar syndrome. To our knowledge, this has not been previously described in connection with this syndrome.

Abnormalities, Multiple↗
PubMed2001

Complete bony fusion of the mandible to the zygomatic complex and maxillary tuberosity: case report and review.

Congenital craniofacial disorders represent approximately 20% of all birth defects. One of these disorders is syngnathia, of which only 24 cases have been reported since 1936. Twenty cases involved fusion of the alveolar processes of the maxilla and mandible. Only four are similar to the presented case, which includes bony fusion of the ascending ramus of the mandible to the zygomatic complex and the posterior part of the maxilla. This case report will present details from the 23rd week of gestation to 8 months of age when the infant underwent the first attempt to free the syngnathia. The literature is discussed and a causative mechanism and new classification are proposed.

Adult↗
PubMed2001

Intraoral mandibular distraction osteogenesis: special attention to treatment planning.

PURPOSE: To demonstrate our experience using internal devices for unidirectional distraction osteogenesis in treating different mandibular hypoplasias (with or without maxillary deformities). An algorithmic table for diagnosis, and treatment planning is presented. PATIENTS AND METHODS: Twenty internal distraction devices were used in 16 patients with mandibular hypoplasia. Deficiency in length of the mandible was calculated on three-dimensional computed tomography scans. The device was activated by a transcutaneous pin on the fifth postoperative day. Distraction was achieved at rates of 0.5 mm/12 h. After a variable period of consolidation the devices were removed. Mean follow-up was 18 months. RESULTS: Successful distraction osteogenesis was achieved in all patients. No premature consolidation or pseudoarthrosis was observed. Improvement of facial aesthetics was produced in all cases. Final occlusion was excellent in those cases where no simultaneous maxillary deformity was present. Orthodontic treatment was applied in all cases. Results remained stable one year postoperatively. CONCLUSIONS: The occlusal results obtained in this series show that we can plan distraction as a definitive treatment in cases with isolated mandibular hypoplasia. When an additional maxillary deformity is present, mandibular distraction must be performed first if indicated, but a maxillary procedure will be necessary later.

Adolescent↗
PubMed2002

[Sonography in callus distraction of the hypoplastic mandible].

OBJECTIVES: Since the early 1990's when callus distraction of hypoplastic mandibles was developed, surgeons have been looking for a reliable method to monitor distraction treatment. X-rays films resulted in insufficient quality of images of low calcified structures and are only of little support in follow-up. Therefore, a standardised protocol using ultrasound was introduced. METHODS: 24 patients were included (aged 4 - 29 years with hemifacial microsomy [19], mandibulary micrognathia [5]), 20 intraoral (Howmedica-Leibinger/Mühlheim) and 9 extraoral distractors (Normed/Tuttlingen). Standard procedures for intra- and extraoral distraction were carried out and all postsurgical treatment steps were monitored by ultrasound. RESULTS: The mineralisation of the neocallus shows the following sequence: echogenic dots, needles directed along the distraction direction, bands, plaques, and modulation of the neocompacta. Additional therapeutically relevant questions of distraction distance, inflammation or occurrence of pus, arising during treatment were answered by sonography. Distance measurements could be performed reliably. CAT scan and MRI cannot be carried out because of metal artefacts. X-ray pictures like orthopantomogram and Clementschisch projection cannot show the early mineralisation and do not allow an exact distance measurement. CONCLUSIONS: Sonography is a effective, method to investigate the callus field without using X-rays and supports monitoring and decision making in distraction treatment of hypoplastic mandibles.

Adolescent↗
PubMedDate not supplied

[Catel-Manzke syndrome].

The leading symptom of Catel-Manzke syndrome is a characteristic deviation of index fingers. Further the patients suffer from symptoms of Pierre-Robin syndrome (micrognathia, glossoptosis, cleft palate). The survival of patients, mostly male, depends on the severeness of congenital malformation of the face skull. The rare disease is demonstrated and discussed by two own cases.

Cleft Palate↗
PubMed1995

Lack of mandibular movement manifested by absent fetal swallowing: a possible factor in the pathogenesis of micrognathia.

This study was performed to assess the association of lack of mandibular movement as manifested by absent fetal swallowing and micrognathia in a nonrestrictive intrauterine environment. Over a 5-year period, 14 fetuses with sonographic findings of polyhydramnios (amniotic fluid index [AFI] more than 20 cm), absent mandibular movement, and a nonvisualized fetal stomach, all consistent with absent fetal swallowing, were followed. A group of 14 fetuses, each with polyhydramnios (AFI more than 20 cm), yet with sonographic detection of fetal swallowing, served as controls. All gravidas in both groups were normoglycemic throughout gestation. Subsequent mandibular development was assessed at delivery or autopsy. Analysis of the data revealed that in the study group, 12 of these infants were liveborn, and two were stillborn. Eleven of the liveborn infants had an early neonatal death. All 14 infants of the study group demonstrated micrognathia. None of the control infants (all of whom survived) had micrognathia. In conclusion, this study supports the concept that normal mandibular growth may depend on the presence of mandibular movement during intrauterine development.

Adult↗
PubMed1993

Sonographic measurement of the fetal mandible: standards for normal pregnancy.

Measurements of the fetal mandible were made on 204 women with uncomplicated pregnancies and reliable gestational dates. The measurements were made in the sonographic plane, which included the fetal mandible and the hypopharynx. The antero-posterior and transverse jaw measurements increased with gestational age (p < 0.0001), and correlated well with both the biparietal diameter and femur length (p < 0.0001). Measurements were technically more difficult to obtain during the late third trimester. These standards for fetal jaw measurement may be useful in the sonographic identification of micrognathia.

Embryonic and Fetal Development↗
PubMed1985

[Dysplasia of the corneal limbus, the mesodermal iris layer and the jaw skeleton in a family].

Ten members of the family B./A. (belonging to two generations) who had dysplasia of the anterior mesodermal layer of the iris were examined. Several of them also had moderate microcornea. The shape of the skull was remarkable, with micrognathia, in some cases combined with mandibular prognathism and early loss of the teeth. Members of the older generation suffered from pannus, although only pingueculae had been present in youth and adolescence. The anomaly of the anterior part of the eye combined with "dysostosis maxillofacialis" (Peters and Hövels) may represent an abortive form of Rieger's syndrome. An aggressive pannus does not appear to have been described before in this syndrome or related diseases.

Adult↗
PubMed1999

Current concepts in aesthetic orthognathic surgery.

While orthognathic surgery provides a significant improvement in masticatory, dentofacial, and airway function, proper and considered preoperative planning can significantly enhance facial harmony and balance as well. Also, orthognathic procedures to correct underlying skeletal discrepancies in concert with, or prior to, other cosmetic procedures can greatly enhance the patient's final result. This paper reviews the use of the occlusal plane angle as a guide for improved aesthetic results with bimaxillary orthognathic surgery. It also provides several examples of facial cosmetic procedures performed as an adjunct to dentofacial surgery. A rationale of timing of these procedures is offered.

Adult↗