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PubMed1984

A soft-tissue cephalometric analysis and its use in orthodontic treatment planning. Part II.

To summarize, the soft-tissue profile can vary in many ways and still be in balance and harmony. There is a wide range of acceptability regarding soft-tissue chin position in the profile. Both the lips and the chin should line up near the H line, but we need to look at the upper lip from a different perspective or in its relation to a line perpendicular to the Frankfort plane and tangent to the vermilion border to be certain that we are planning the best possible lip support for the case at hand. The H angle, allowing a few degrees for soft-tissue thickness variability, must increase as the basic skeletal convexity increases, and as the convexity increases, the lower incisors will need to be left farther forward than in a straight or concave skeletal profile. A thick integumental covering in the chin area can also effectively align the lower facial profile where lower incisors are farther forward than we are accustomed to seeing them. This principle can also be applied by surgically moving the bony chin forward until the three key soft-tissue points line up. Because there are wide variations in skeletal convexity, standardizing the position of the lower incisor to its apical base support as measured in the Frankfort mandibular incisor angle fails to recognize that upper incisors can be retracted too far, leaving a "streamlined" upper lip which is not esthetically pleasing. Locating the lower incisor in relation to the expected point A to pogonion line is somewhat better but still fails to recognize the wide range of variability in the thickness of the lips and soft-tissue chin. We must also guard against "dishing" those cases having good facial balance with quite normal skeletal convexity and only 5 mm or 6 mm of lower arch length discrepancy. Finally, it is completely practical as a treatment-planning procedure to approach the proposed orthodontic changes from a soft-tissue analysis perspective, making changes only to the point where the best possible soft-tissue profile is established, and then compute the tooth movement necessary to develop ideal profile relationships. The visualized treatment objective, or VTO, is the vehicle that I use to accomplish this.

Adult↗
PubMed1993

Heritability of cephalometric and occlusal variables as assessed from siblings with overt malocclusions.

It has been thoroughly documented that measurements of the craniofacial complexes have moderate to high heritabilities--that they are primarily a consequence of "nature" rather than "nurture." In contrast, recent studies, which used twin and sibship analyses, have shown that malocclusions per se (i.e., measures of tooth position and dental interrelationships) have low heritabilities; malocclusions sensu stricto are primarily acquired (environmentally induced), not inherited. All such studies have, however, focused on persons not treated orthodontically. This can introduce selection bias since cases with moderate to severe malocclusions would have received treatment and, thus, be excluded from study. The present analysis addresses this issue of ascertainment bias by examining just that portion of the adolescent population receiving comprehensive orthodontics. Initial treatment records of 104 pairs of siblings were studied, all of whom subsequently received full-banded treatment. In this selected series of overt malocclusions, heritability estimates for craniometric variables were significantly lower than in a comparable series of adolescents with naturally occurring good occlusions, whereas heritability estimates for occlusal variations (e.g., rotations, crossbites, displacements) were significantly higher. This vindicates the clinical perception that siblings often present with similar malocclusions. We propose that the substantive measures of intersib similarity for occlusal traits reflect similar responses to environmental factors common to both siblings. That is, given genetically influenced facial types and growth patterns, siblings are likely to respond to environmental factors (e.g., reduced masticatory stress, chronic mouth-breathing) in similar fashions. Malocclusions appear to be acquired, but the fundamental genetic control of craniofacial form often diverts siblings into comparable physiologic responses leading to development of similar malocclusions.

Adolescent↗
PubMed2003

Genetically altered mouse models: the good, the bad, and the ugly.

Targeted gene disruption in mice is a powerful tool for generating murine models for human development and disease. While the human genome program has helped to generate numerous candidate genes, few genes have been characterized for their precise in vivo functions. Gene targeting has had an enormous impact on our ability to delineate the functional roles of these genes. Many gene knockout mouse models faithfully mimic the phenotypes of the human diseases. Because some models display an unexpected or no phenotype, controversy has arisen about the value of gene-targeting strategies. We argue in favor of gene-targeting strategies, provided they are used with caution, particularly in interpreting phenotypes in craniofacial and oral biology, where many genes have pleiotropic roles. The potential pitfalls are outweighed by the unique opportunities for developing and testing different therapeutic strategies before they are introduced into the clinic. In the future, we believe that genetically engineered animal models will be indispensable for gaining important insights into the molecular mechanisms underlying development, as well as disease pathogenesis, diagnosis, prevention, and treatment.

Animals↗
PubMedDate not supplied

Growth mechanisms in skulls with facial clefts. Descriptive and experimental studies on the facial skeleton.

During postnatal growth, skulls of patients with untreated unilateral clefts of the alveolus and palate develop additional anomalies of the facial skeleton. Similar anomalies--a deviation of the upper jaw to the non-cleft side and retropositioning of the maxilla on the cleft side--develop in rabbits with the same type of cleft, surgically produced in the fourth week after birth. Based on a quantitative study of the postnatal growth of the rabbit skull under normal and various experimental conditions, a mechanisms is proposed for the late developement of anomalies of the facial skeleton in cleft-affected skulls.

Abnormalities, Multiple↗
PubMed1992

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. II. Mandibular and vertical development.

Lateral skull radiographs of 85 patients with unilateral clefts of the lip, alveolus and palate treated according to four different regimes were compared longitudinally, at three different ages, regarding mandibular and vertical facial development. It was found that there were no lasting differences in mandibular morphology resulting from regimes including primary or early secondary bone grafting. The non grafted group, however, showed increased mandibular length and anterior height. The jaw angle was increased and there was a more favourable sagittal jaw relationship. Regimes that included primary bone grafting were associated with reduced upper anterior facial height, which resulted in less harmonious facial proportions compared with treatment regimes including early secondary bone grafting done during the mixed dentition, or no bone grafting at all. Vertical development was greatest where bone grafting was excluded.

Alveolar Process↗
PubMedDate not supplied

Ten years without orbital optic nerve: late clinical results after removal of retrobulbar gliomas with preservation of blind eyes.

Surgical removal of gliomas of the orbital optic nerve by the transconjunctival approach with preservation of the associated eyes was successful and has been reported in several cases. The central retinal arteries in the anterior optic nerves were proven histologically to have been excised along with the gliomas in all cases. Due to suspected variations of blood supply, however, the retinal blood vessels postoperatively remained blood-filled in these blind eyes, and the eyes could be maintained. Follow-up of about 10 years in two cases with surviving blind eyes after surgical excision of large optic nerve gliomas revealed normal development of lids and orbit, good muscle function, and relatively good cosmetic appearance as well as satisfied patients.

Blindness↗
PubMedDate not supplied

Facial growth and development during puberty in unilateral cleft lip and palate: a longitudinal study.

Roentgencephalometry was used for longitudinal assessment of facial growth and development in 20 boys and 23 girls (age range 10-15 years), with complete unilateral cleft lip and palate. A marked limitation of growth showed the depth of the upper jaw and the height of the upper lip whereas the most intense growth was present in variables characterizing the prominence of the nose. The growth rate was always higher in boys than in girls who had a more pronounced prognathia of the lower jaw. However, the development of the face proceeded identically in both sexes. In contrast with the increasing protrusion of the lower jaw was the increase of the retrusion of the upper jaw, and this led to a flattening of the facial profile and an impairment of sagittal jaw relations. The excessively steep mandibular body and the vertical disproportion of the face remained unchanged. Sagittal jaw relations deteriorated in three fourths of the patients, facial convexity in more than 90%, and neither condition showed any signs of improvement. It was possible to maintain the overjet at the same level as it was at the beginning of puberty; an improvement was attained with fixed appliances. The little scatter of developmental changes of mandibular rotation and the assessment of some correlations were suggestive of an individually constant postoperative character of facial development in clefts. Correlation coefficients disclosed that a more unfavorable condition at the age of 10 years did not imply a subsequent more marked deterioration of development during puberty. Mandibular rotation was not correlated with facial convexity, sagittal jaw relations, or overjet. The possibility of an improvement of overjet by the use of removable appliances was limited by the development of the ANB angle. The use of fixed appliances led to a reduction of this limitation.

Adolescent↗
PubMed1988

Developmental effects of impaired breathing in the face of the growing child.

Craniofacial morphology and occlusal pattern are evaluated in 71 subjects having impaired breathing as diagnosed by an otolaryngologist, and in an equal number of controls. The impaired group demonstrate characteristic combinations of craniofacial deformities and malocclusions, with the younger individuals demonstrating a lesser expression of malocclusion progression and morphologic deformities. This suggests that early recognition of such facial patterns may be utilized to identify those breathing compromised individuals who have a likely tendency to develop certain types of malocclusion.

Adolescent↗
PubMed1998

Functional properties of jaw and tongue muscles in rats fed a liquid diet after being weaned.

Decreased masticatory demands due to liquid or soft diets cause a reduction in the growth of craniofacial bones and in the development of feeding musculature, but the effects on masticatory function and jaw/tongue muscle activities are unclear. The present study was undertaken to test the hypotheses that a liquid diet feeding after weaning affects the critical-period programming of mastication and the motor performances of jaw and tongue muscles. Thirty-six male Wistar rats were divided into two equals groups at weaning and fed either a solid (solid-diet group) or a liquid (liquid-diet group) diet until they reached 50 days of age. Electromyograms (EMG) of the masseter, medial pterygoid, temporalis, anterior digastric, styloglossus, and genioglossus were recorded while animals were naturally ingesting ordinary pellets, apple cubes, and a liquid diet. It was found that: (1) a more irregular chewing rhythm, a shorter chewing sequence, and a longer chewing cycle were found in the liquid-diet group, but there were no differences observed during lapping/licking between the two groups; (2) during the chewing cycles, the EMG onset of each muscle in relation to that of the masseter in the liquid-diet group was similar to that in the lapping/licking cycles in both groups; (3) the activities of jaw elevators (masseter, medial pterygoid, and temporalis) during the chewing cycles were significantly higher in the liquid-diet group; and (4) the increase in the EMG activities of jaw elevators during pellet chewing compared with apple cube chewing was significantly weaker in the liquid-diet group, whereas such an enhancement was found simultaneously in the styloglossus in the solid-diet group, and in the anterior digastric in the liquid-diet group. These findings verify that: (1) the motor output of jaw and tongue muscles may be altered in rats fed a liquid diet after being weaned; (2) the feeding of a liquid diet to rats after being weaned may obstruct the functional transition from suckling to mastication; and (3) jaw elevators that develop without motor learning of mastication are inefficiency when performing functionally.

Analysis of Variance↗
PubMed2004

Perspectives on growth factors and orofacial development.

Despite the fact that orofacial clefts represent one of the most common birth defects, the molecular mechanisms by which the embryonic primordia of the midface grow and differentiate are not completely understood. A multiplicity of genes must be expressed and their protein products must interact in a highly orchestrated fashion to affect normal orofacial development. Several families of growth factors have emerged as key contributors to the choreography of cellular and tissue interactions contributing to morphogenesis of the orofacial region. This overview focuses on those growth factors that are generally accepted as playing a pivotal role in normal as well as abnormal development of first branchial arch-derived structures. Particular emphasis is given transforming growth factor-beta (TGF beta) and TGF alpha family members, as these have been the most extensively investigated with regard to their role in development of orofacial structures. Consideration is also given to evidence implicating developmental contributions from members of the bone morphogenetic protein and fibroblast growth factor families.

Animals↗
PubMed2006

Effects of growth hormone on craniofacial growth.

OBJECTIVE: This study determined the effects of growth hormone (GH) therapy on craniofacial growth in idiopathic growth hormone deficiency (GHD). MATERIALS AND METHODS: Fifty-seven patients (33 boys and 24 girls; age range 4.5 to 16.7 years) with GHD were investigated and categorized into three groups according to the duration of GH therapy: the untreated group, the short-term therapy group, and the long-term therapy group. Their lateral cephalometric radiographs were studied, and craniofacial measurements were assessed by age and sex by using matched standard deviation scores. RESULTS: In the untreated group, the anterior cranial base, total facial height, maxillary length, mandibular total length, mandibular body length, and ramus height were smaller than the standard values. In comparison with the untreated group, the long-term therapy group had a significantly larger upper facial height (P < .05), maxillary length (P < .01), and ramus height (P < .01) measurements. CONCLUSIONS: Children who received long-term GH replacement therapy showed increased growth of the craniofacial skeleton, especially the maxilla and ramus. These findings suggest that GH accelerates craniofacial development, which improves occlusion and the facial profile.

Adolescent↗
PubMed1989

[Morphogenesis of the cranial base].

The literature on normal morphogenesis and growth of the human cranial base was reviewed. The development of the cranial base was considered in three overlapping phases: membranous, cartilaginous and osseous. Special interest was focused on the osseous phase. The role of the synchondroses, sutures and bone remodelling in normal development was analysed. The cranial base was described as a buffer structure and as a template for the final form of the face.

Adolescent↗
PubMed1992

Adenotonsillectomy for upper airway obstruction carries increased risk in children with a history of prematurity.

To define better the clinical presentation and perioperative outcome in children undergoing adenotonsillectomy (T&A) for relief of upper airway obstruction (UAO), we reviewed the hospital records of 60 consecutive, otherwise normal children aged 12 years or younger. Seven patients with trisomy 21, neurologic impairments, or preoperative cor-pulmonale were excluded. Intraoperative and postoperative complications were experienced by 15 (34%) and 13 (25%), respectively, of the 53 children with preoperative UAO. The most severe complications comprised pulmonary edema and prolonged postoperative oxyhemoglobin desaturation. Multivariate logistic regression analysis found a history of prematurity and/or low birth weight to be the most significant risk factors related to the occurrence of complications. Twenty-eight % of the study population had a history of prematurity and they had approximately 85% of the perioperative complications seen in children with UAO undergoing T&A. Other significant risk factors included adenoidal facies and evidence of respiratory distress at the time of surgery. It appears that T&A poses significant risk for children with UAO who were born prematurely and have evidence of abnormal facial development or respiratory distress preoperatively.

Adenoidectomy↗
PubMed2005

A longitudinal 3-dimensional size and shape comparison of untreated Class I and Class II subjects.

BACKGROUND: The invention of the Broadbent-Bolton cephalometer in 1925 made possible the collection of 3-dimensional data from biorthogonal plain film head radiographs. The objective of this study was to compare longitudinal changes in the shape and size of craniofacial structures between 16 untreated Class II Division 1 girls and 16 untreated Class I Bolton girls. METHODS: Procrustes analyses were used to compare differences in 30 cephalometric landmarks that were 3-dimensional. The same methods were also used to analyze changes of 4 subsets of landmarks (maxilla, mandible, midface, and cranial vault). Comparisons included shape and size differences between adjacent age groups at ages 6, 11, and 15 in the Class II sample as well as between the Class I and Class II samples at each age. RESULTS: Overall, the craniofacial complex underwent continuous shape change from ages 6 to 15 in both samples. In the Class II sample, the smallest contribution to craniofacial shape change was seen for the mandibular landmarks between ages 6 and 11. Compared with the Class I sample, the Class II sample had (1) a longer facial pattern, (2) the smallest mandibular shape difference at age 6 and the largest at age 15, and (3) more protrusive maxillary landmarks at all ages compared with the Class I sample. The Class II sample also had the largest change in size from ages 11 to 15 (6.5%), whereas the Class I sample showed the greatest size change (10.5%) from ages 6 to 11. CONCLUSIONS: Clinically significant size and shape differences were observed during growth and development between Class II and Class I subjects in this sample.

Adolescent↗
PubMed1997

A size-standardized analysis of soft tissue facial profile during growth.

A method for the quantitative and qualitative analysis of the facial soft tissue profile has been developed and applied to analyze the age differences in lateral cephalograms for the annual Bolton standards from ages 1 to 18 years. To standardize for different facial sizes, profiles were traced in polar coordinates without modifications of facial shape. Most of the soft tissue landmarks showed progressive modifications from birth to 18 years of age. Soft tissue nasion and lower lip had a steep change between 2 and 3 years of life, pronasale between 3 and 5 years of life, A', upper lip, and stomion between 4 and 5 years of life. Hereafter, all these landmarks but N' had several minor modifications progressing toward the adult value. Soft tissue nasion did not modify significantly after 2 years of age. Conversely, changes in the relative positions of B' and Pg' were more scattered in the analyzed period. Age-related size differences were more linear than shape modifications, with gradual increments from 1 to 18 years of age. The method allowed a simple and rapid quantitative evaluation of soft tissue profiles during facial growth. An approximate evaluation of the soft tissue thickness at nose, lips, and chin was also possible. No particular mathematical knowledge was required at any step of the analysis. Results were in good agreement with the well-known patterns of normal growth and development, thus confirming the practical possibilities of the method.

Adolescent↗
PubMed2003

Msx homeobox gene family and craniofacial development.

Vertebrate Msx genes are unlinked, homeobox-containing genes that bear homology to the Drosophila muscle segment homeobox gene. These genes are expressed at multiple sites of tissue-tissue interactions during vertebrate embryonic development. Inductive interactions mediated by the Msx genes are essential for normal craniofacial, limb and ectodermal organ morphogenesis, and are also essential to survival in mice, as manifested by the phenotypic abnormalities shown in knockout mice and in humans. This review summarizes studies on the expression, regulation, and functional analysis of Msx genes that bear relevance to craniofacial development in humans and mice. Key words: Msx genes, craniofacial, tooth, cleft palate, suture, development, transcription factor, signaling molecule.

Animals↗
PubMed1985

Craniofacial surgery for craniosynostosis improves facial growth: a personal case review.

An evaluation of 220 cases of frontocranial remodeling for craniosynostosis is reported. The follow-up period was 10 years for children, 7 years for infants. The principles of the craniofacial techniques described in 1974 [4] and 1978 [3] were not modified; only variations were added. The floating forehead [5] concept has also remained basically unchanged. Intracranial pressure recordings have been used continually to help evaluate borderline indications and to assess results [9]. Our results show that 14% of cases of craniosynostosis affecting only one suture, usually considered as merely aesthetic problems, in fact were accompanied by increased intracranial pressure. The postoperative recordings have shown a return to normal pressures. Growth has not deteriorated the initially satisfactory results at the level of the forehead. At the midface level, improvement has been observed after surgery, especially for plagiocephalics. Their orbitonasal asymmetry has nearly completely disappeared. Patients with bilateral faciocraniosynostosis show an improvement of midface development compared with non-operated patients, but in severe cases an inverted bite still develops and further facial osteotomies remain necessary. The Apert's patients remain the most difficult to improve.

Child↗
PubMed2003

Clinical treatment of oral manifestations of Beckwith-Wiedeman syndrome in a child.

Orthodontic treatment in a young patient with Beckwith-Wiedeman Syndrome (BWS) is reported and a multidisciplinary approach to the management of this syndrome is reviewed. The patient presented with a tendency to Class III malocclusion, an open-bite and a slight macroglossia, which was treated at an early age by glossotomy. It was decided to monitor growth without treatment and to wait for the best time to begin therapy. It was based only on functional rehabilitation, without any fixed appliances, in which optimum intercuspation of the teeth and the skeletal Class I relationship was achieved and maintained after the retention period of three years. In conclusion the treatment of BWS patients requires a multidisciplinary approach that includes orthodontics, orthopaedics and surgical intervention. It is also necessary to underline the significance of diagnosis at an early age and timely treatment to reduce the development of dento-skeletal alterations.

Adolescent↗