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Acquired craniofacial features associated with chronic phenytoin therapy.

Although the teratogenic effect of phenytoin on the fetus has been well-documented, the effect on postnatal facial structure has not been emphasized. The evolution of such changes is illustrated with serial photographs and case histories of five mentally retarded individuals not known to have diagnoses that could account for these dysmorphic features. The intent of this report is to increase awareness of this serious consequence of phenytoin therapy and to stimulate interest in further studies of the phenomenon. The incidence and prevalence, mechanism of production, genetic predisposition, and critical age for development of this effect in patients treated with phenytoin needs to be determined.

Adult↗

Management of severe partial hypodontia: case report.

Hypodontia is characterized by partial or total congenital missing of one or more teeth, on one or both dentitions. Heredity is the main etiological factor and the principal clinical features are reduction on number, size and form of teeth, and late eruption. Removable partial prosthesis, fixed prosthesis, overdentures and adhesive prosthesis are alternative treatments; and the indication is type dependent. The aim of this study was to describe the clinical case of an eleven-year-old child with eight missing permanent teeth of idiopathic etiology. The patient had facial and skeletal symmetry, normal development and was not related to any syndrome. Clinical characteristics: permanent teeth with good periodontal conditions (16, 12, 11, 21, 22, 26, 36, 31, 42, 46), primary teeth (53, 63, 64, 73, 83); overbite and microdontia on teeth 12 and 22. The treatment plan was done initially by documenting of the case for teeth analysis (study casting models, periapicals and panoramic x-rays, and photographs), and followed by the exodontics of teeth 73 and 83. A removable appliance in autocured acrylic resin, using teeth in acrylic for maintenance of functional space and occlusion was planned and carried out. An anterior track for vertical dimension gain was used because of his accentuated overbite. The patient will be monitored until the end of the craniofacial growth, when it will be again evaluated and forwarded for the final oral rehabilitation. Hypodontia diagnosis and management should be performed as early as possible not to interfere with the craniofacial development of the child.

Age Factors↗

The Polynesian head: growth and form.

We consider the cranial base to be the primordial determinant of the head form and mandibular shape so common amongst (but not exclusive to) adult Polynesians. The flatness of the cranial base manifests its full influence only when growth of the upper facial skeleton is complete in early adulthood. We argue that during growth and maturation the upper facial skeleton and the maxillary occlusal plane are required to adjust in position to a major extent according to the template set out by the flat cranial base, with consequent obligatory and extreme adjustment in shape and position of the mandible in order that occlusion be maintained. The base is constrained from adjusting its own shape significantly by virtue of its intimate relationship with the brain and the emerging cranial nerves. The structural consequences of these adaptations are seen in the bony profile, which is vertically disposed and orthognathic, and in the large nasopharynx, while functionally the relative inefficiency of the mandible as a lever requires extensive compensatory development of masticatory musculature which influences the shape of the face and vault.

Adolescent↗

Nasomaxillary skeletal dimensions complex in patients with osseous nasal septum deformities.

Controversy still exists regarding the precise contribution of the nasal septum to facial growth and development. Several reports indicate that early surgical intervention for the correction of nasal septum abnormalities leads to a high recurrence rate that necessitates revision procedures in adulthood. In this study we compared a group of patients with posterior nasal septum deformities to a control group by using cephalometric radiographs and recording several measurements on composite tracings. Our data, analysed by a computerized statistical programme, demonstrate significant differences between the two groups, supporting the view that the development of the anterior part of the neurocranium influences the development of posterior nasal septum deformities.

Adolescent↗

Facial balance in cleft lip and palate. I. Normal development and cleft palate.

A full understanding of balanced facial growth, based on a complete knowledge of the anatomy and physiology of the region, is essential if cleft lip and palate is to be treated successfully. The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Cleft surgery must aim to restore normal anatomy and physiology with emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be achieved.

Adult↗

Cranial base morphology in cleft lip and palate: a cephalometric study from 7 to 18 years of age.

Four cleft lip/palate groups were cephalometrically compared with a noncleft control group using three cranial base dimensions: anterior (ACB) and posterior (PCB) cranial base, and cranial base angle (CBa). The groups were compared by age from 7 to 18 years. The results showed that the cleft lip and/or alveolus group was not different from the control group in the three dimensions. Unilateral and bilateral cleft lip and palate and isolated cleft palate cases were generally shorter in ACB and PCB for most of the growth period, particularly after age 8 to 9 years. The cranial base angle remained similar for all the cleft groups when compared with the noncleft group. These findings support the view that intrinsic tissue defects or errors during embryologic development may result in basicranial abnormalities and orofacial clefting.

Adolescent↗