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PubMed1997

Morphologic study of the mandibular fossa and the eminence of the temporomandibular joint in relation to the facial structures.

To clarify the relationship between the temporal component of the temporomandibular joint and facial bone structure, we measured anthropologic craniometric points and the structure of the mandibular fossa, including the eminence in 33 Japanese male dry skulls, with a three-dimensional apparatus. The length from the articular tubercle to the medial glenoid tubercle is correlated with skeletal variables such as the length of the fossae, the width of the masseter origin, and the mandibular length. Therefore it appears that the frontal dimension is related to the facial development, which is attributable to bite force. Goniometrically, the angle between the line deepest point of the fossa--the midpoint of the eminence and the Frankfort horizontal plane (middle angle)--was negatively correlated only with the ANB angle, suggesting that a steeper middle angle of the eminence is related to a retrusive maxilla or protrusive mandible.

Adolescent↗
PubMed1988

Sports-related maxillofacial fractures in a hospital material.

Sports-related maxillofacial fractures were analysed in 80 patients, accounting for 5.6% of all patients with facial bone fractures, treated during the 5-year period 1981-1985. 55% of the patients had 1 or more mandibular fractures and 45% had midface fractures. 6% of the patients had multiple injuries. The most common causes of injury were collision and fall. Soccer and ice hockey turned out to be the most hazardous sports, although sports-related maxillofacial fractures were less severe than those related to other causes. The need for oral and facial protection among athletes involved in contact sports is discussed.

Adolescent↗
PubMed1989

Microvascular surgery as an adjunct to craniomaxillofacial reconstruction.

Fifteen patients (8 female and 7 male) age 4 to 57 years underwent microsurgical free tissue transfers as a component of a craniomaxillofacial reconstruction. In 12 patients the free flap was performed simultaneously with the bony procedure and in three it was a secondary procedure. The patients included two craniosynostosis, four craniofacial tumours, five hemicraniofacial microsomias, one facial and skull base arteriovenous malformation, one orbitofacial neurofibromatosis and two hemifacial atrophies with extensive facial skeletal involvement. The rectus abdominis free flap was used in 9 patients, the latissimus dorsi in two, the omentum in three, and the first web-space in one. The choice of tissue varied according to the size of the defect and its location. The rectus abdominis musculofasciocutaneous flap was the most frequent source of tissue for contour restoration, and the omentum was used to fill intracranial spaces. One flap failed intraoperatively in a patient with hemifacial microsomia and inadequate and abnormal recipient vessels. One patient had an injury to the temporal branch of the facial nerve, with spontaneous recovery. In 13 patients the free tissue transfer was for soft tissue fill with cover of facial bone or skull base; secondary procedures were frequently required in these patients. In two patients with intracranial free flaps, no further procedures were necessary. In selected cases the association of microvascular techniques with craniomaxillofacial surgery can facilitate reconstruction and improve results.

Adolescent↗
PubMed1975

The skull in gonadal dysgenesis. A roentgenometric study.

Skull radiographs of 54 patients with Turner's syndrome have been studied. The following characteristic findings were frequently noted: mastoid processes of definitely decreased dimensions, small facial bones which were proportional to the stunted growth of the patients, enlargement and increased thickness of the mandible, extensive calcification of the petro-clinoid ligaments, excessive pneumatisation of the paranasal sinuses and increased angle of the base of the skull.

Adolescent↗
PubMed2005

Blood loss and transfusion rates during repair of craniofacial deformities.

Surgical procedures for correction of craniofacial deformities resulted in unavoidable and extensive blood loss in small children and infants. Almost all of the patients undergoing these procedures will undergo a blood transfusion either during or immediately after the operation. A retrospective review of 30 patients who underwent craniofacial surgery was performed in this study to determine the magnitude of transfusion required for craniofacial surgery, document transfusion morbidity, and identify variables associated with the transfusion. The mean estimated blood loss was 566.8 mL, the mean intraoperative transfusion was 394.8 mL, the mean postoperative transfusion was 103.2 mL, and the mean total transfusion was 505 mL. The mean operative time was 450 minutes, the mean preoperative hemoglobin and the mean postoperative hemoglobin before hospital discharge were 11.6 g/dL and 10.3 g/dL, respectively. Craniofacial surgical procedures involve extensive scalp dissection and calvarial and facial bone osteotomies in patients with a low total blood volume. Every medical and surgical strategy for minimizing the need for blood transfusion should be considered.

Blood Loss, Surgical↗
PubMed2004

Congenital arhinia with de novo reciprocal translocation, t(3;12)(q13.2;p11.2).

A female newborn suffering from congenital arhinia with complete airway obstruction is reported. In addition, she had hypertelorism, microphthalmia, high-arched palate, and hypoplasia of the auditory canal and mastoid and facial bones, along with the absence of olfactory bulbs and tracts. She had a de novo reciprocal translocation between chromosomes 3q13.2 and 12p11.2. Certain gene(s) located at either of the breakpoints, 3q13.2 and 12p11.2, may be involved in the pathogenesis of her arhinia.

Abnormalities, Multiple↗
PubMed1975

The use of the fiberoptic bronchoscope to facilitate endotracheal intubation following head and neck trauma.

The fiberoptic bronchoscope is an invaluable aid in the difficult endotracheal intubation. Its successful use with three patient groups is described: those with soft-tissue contractures of the mouth or neck; those with severe fractures of facial bones and/or mandible; those with unstable fractures or fracture-dislocations of the cervical spine. Fiberoptic bronchoscopy is felt to be the technique of choice when intubation is difficult, especially when there are contractures or deformities of the larynx, manidible, or cervical spine.

Adult↗
PubMed1997

Radiographic cephalometry of the facial profile.

Radiographic cephalometry is a biomorphological measuring method used in the prosthodontics as well, and for the facial profile analysis of persons with complete dentures. The purpose of this examination was to objectivize the facial esthetics in patients with complete dentures. The measurements were taken from LL X-ray radiographs obtained by the apparatus "Ortoceph 10" (Siemens, Bensheim, Germany). On the sample of 80 subjects a convexity angle of facial bone structures (N-A: A-Pg) and profile angle of soft facial tissue (ft-unt: lnt-ct) have been examined. The subjects were divided into a group with upper and lower complete dentures (20 males and 20 females) and a group with natural teeth of eugnatic characteristics (20 male and 20 female). The measurements were taken by standard protractor at 0.5% precision. The statistical analysis within and among groups has been made by F-test and t-test respectively. The results showed that the bone structure convexity angle span a range between 0 degree and 5.5 degrees (X = 2.5 degrees), and the facial profile angle between 139.5 degrees and 155 degrees (X = 149 degrees) in persons with complete dentures. In persons with natural teeth the values of bone structure convexity angles span a range between -0.5 degree and 4.8 degrees (X = 2 degrees), and the facial profile angle between 136 degrees and 155.5 degrees (X = 151 degrees). The results of tests proved that there were no statistically significant differences in examined variables between persons with natural teeth and those with complete dentures (p > 0.05). The conclusion is that clinical methods of determining the vertical and horizontal intermaxilliary relations used in the designing procedures of complete dentures were reliable enough in reconstruction of examined angles of soft and hard facial profile structures.

Case-Control Studies↗
PubMed1994

Bony injuries in association with minor head injury: lessons for improving the diagnosis of facial fractures.

One hundred consecutive admissions for minor head injury over a 12-week period in 1992 were analysed for all associated bony injuries. Fractures of the facial bones were found to be the commonest concurrent injury. A number of these were missed in the Accident and Emergency Department either due to inadequate radiographic views or incomplete recognition of clinical and radiological findings. A protocol for assessment of injury to the head and face is suggested.

Adolescent↗
PubMedDate not supplied

Pediatric cranio-facial surgery. First-year's experience with a gun applying bioabsorbable tacks.

AIM: In 2001 a prototype of a gun to apply bioabsorbable tacks in cranio-facial surgery has been developed. METHODS: From May 2001 to May 2002 this device has been used in the University Hospital of Innsbruck (Austria) for different cranioplasty procedures, in 34 children, showing its reliability for cranio-facial bone fixation. The children were affected by isolated craniosynostosis or by syndromical synostosis (Apert, Crouzon) and in a case of benign tumor of the parietal skull vault. The range of age, at the time of surgery, was between 3 months and 204 months of age. Bone segments were fixed using self-reinforced polylactide plates and tacks. RESULTS: Firm fixation was obtained intra-operatively and the operative time was reduced about 25-30 minutes as compared to use of plates and screws. This device has just one limitation in its own spring force: sometimes the bone thinner than 1 mm has been broken applying the tacks. CONCLUSION: After the first-year's experience it is possible to confirm that this device reduces, in selected cases, operative time, blood loss, risk of infection and, as a result, the costs.

Absorbable Implants↗
PubMedDate not supplied

Bioactive glass-ceramics in facial skeleton contouring.

The removal of certain facial-bone defects is a prerequisite to restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative techniques would be an unacceptable burden for a patient. Satisfactory results can be achieved in one surgical intervention with low costs and low demand on technical equipment. Osteoconductive, biocompatible, non-resorbable glass-ceramic implants based on oxyfluoroapatite and wollastonite permit osteointegration--a direct physical and chemical bond between live bone tissue and the implant without formation of a fibrous capsule. They display better stress durability in simulated body fluid than hydroxyapatite implants do. This material was used for facial skeletal framework, contour restoration in 44 cases under conditions where other solutions were doubtful. Patients were observed for 24.8 months. Immediate healing occurred without any adverse reaction. The main problem was extrusion, observed in 20.45% cases over a 2-3 month period after the implantation. All cases, with one exception, were solved with a satisfactory final result by reoperation, implant size reduction, and increased soft tissue cover. This approach was found to be a suitable technique, especially for patients exhausted by prior incompetent treatment but still dissatisfied with their appearance. Successful reconstruction with a bone substitute may remarkably increase quality of life for affected persons and, at the same time, reduce surgery-related time and costs.

Adolescent↗
PubMed1986

Severe craniofacial sclerosis with multiple anomalies in a boy and his mother.

A boy is described with severe hyperostosis of the cranium and facial bones, and many other abnormalities including macrocephaly, abnormal facies, cleft palate, conductive hearing loss, speech defect, dental and digital anomalies, delayed skeletal development, short fibulas, short stature of postnatal onset, cervical kyphosis, and progressive lumbar lordosis. His mother exhibited craniofacial sclerosis, similar dental defects, and mild osteopathia striata without other abnormalities. This family may represent a previously undescribed inherited syndrome with cranial sclerosis.

Abnormalities, Multiple↗
PubMed1989

Further delineation of the Yunis-Varon syndrome.

A boy with intrauterine growth retardation, microcephaly, dysostosis of the skull, hypoplastic facial bones, labiogingival retraction, agenesis of the clavicles, distal aphalangia, and severely hypoplastic thumbs and halluces is described. The features are consistent with the Yunis-Varon syndrome. Review of published reports shows this to be a generalised disorder with variable manifestations in the skeletal, ectodermal, and cardiovascular systems. The consanguinity of the parents of the present case is in agreement with autosomal recessive inheritance.

Abnormalities, Multiple↗
PubMed1994

Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features.

Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation. Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.

Adolescent↗
PubMed1983

Aetiology and incidence of facial fractures in adults.

The incidence, aetiology and trends in fractures of the facial bones occurring in the years 1965, 1970, 1975 and 1980 in the Grampian Region of Scotland are reported. A 2.7 fold increase in incidence occurred during this period. Males are seen to be most at risk and an increase in assault and sports-related trauma is seen. Offshore oil exploration developed during this period and its effects are discussed. Attention is drawn to the differences in the aetiology of right and left malar fractures.

Adult↗
PubMedDate not supplied

High-resolution CT scanning of facial trauma.

Computed tomographic (CT) scanning offers a simple, fast, and accurate study of complex maxillofacial trauma especially in the patient with multiple injuries. At the time of CT brain scanning, the facial bones can be scanned with only minimal extra time. High-resolution scanning provides excellent bony detail equal to or better than complex-motion tomography with the advantage of better contrast resolution as well. Application of craniofacial surgical techniques is facilitated by the accurate display of the nature and extent of fracturing. Surgical findings of extent of fracturing correlate better with high-resolution scanning than with plain films and conventional tomography.

Adult↗
PubMed1995

A new three-dimensional treatment algorithm for complex surfaces: applications in surgery.

PURPOSE: Recent advances in computer technology enable automatic reconstruction of surface models using digitized contour lines and three-dimensional (3D) representation on a graphic terminal. This work was aimed at obtaining 3D reconstructions of facial bones to help guide oral surgery and complex dental implantology procedures. MATERIAL AND METHODS: The starting point was a computed tomographic examination. The limits of the cortical bone were automatically outlined and then digitized using a special computer program. The resulting data were then compiled for computer-aided design (CAD) purposes, and a virtual 3D model of the bone was mathematically computed. This model was next transferred to a computer program that piloted a CAD/computer-aided manufacture (CAM) machine that guided a laser stereolithography process. RESULTS: The early results of the use of 3D images, as well as solid models, for clinical and surgical purposes, indicate a high degree of reliability in morphologic diagnosis, determining the surgical procedure, and establishing the subsequent prognosis.

Algorithms↗
PubMed1992

Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities.

C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.

Accidents, Traffic↗