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Applications of distraction osteogenesis. Part I.

Distraction osteogenesis (DO) of facial bones is a recent development in the treatment of pediatric patients. The use of DO in current clinical practice of pediatric reconstructive surgery is primarily limited to severe deformities of the lower jaw, most of which are congenital in nature. Clinical experience with DO for early facial deformities remains limited, and no authoritative works are currently available to guide clinicians in the techniques or indications for DO of the facial skeleton.

Child↗

Intraoral craniofacial manipulation by using MRI appliance.

This case illustrates the use of the Maxillary-Rotation-Impaction Appliance (MRI) to rotate and impact the maxilla. When this maneuver was completed the transverse expansion screw widened the maxillary arch. The case was completed using fixed orthodontic appliances. The result is that the facial bones appear in the correct position and the teeth are correctly positioned in the face with a class I occlusion.

Cephalometry↗

[Secondarily accelerated foreign bodies as a source of danger from airbag deployment].

BACKGROUND: The use of airbag systems in motor vehicle construction has led to a significant reduction in both the frequency and intensity of injuries during traffic accidents. However, recent reports have shown numerous cases in which it is assumed that the airbag was the major cause of serious injury. CASE REPORT: In a collision with a wild boar, both airbags in the automobile deployed. The driver suffered facial abrasion and belt contusion to the left shoulder. The passenger held a glass bottle in her hands during the impact that, secondarily accelerated through the airbag, hit both eyes and the bridge of her nose. On clinical admission, the patient showed fractures of the nasal bridge, of both medial orbital walls on both sides and a massive periocular haematoma which required direct examination under narcosis. Both eyes showed an orbital contusion, a large area of corneal abrasion, traumatic mydriasis with sphincter tears such as bilateral 90% hyphema. During surveillance, a progressive reduction in visual acuity occurred. After posterior chamber vitrectomy with epiretinal peeling and posterior chamber lens implantation in the left eye, visual acuity was 0.05 in the left eye and 0.01 in the right. CONCLUSIONS: A considerable danger emanates from objects which are situated between head and airbag in the moment of airbag deployment. This requires public education and, in addition, airbag systems which are adapted to the drivers height and weight, as well as to objects in its immediate vicinity.

Acceleration↗

Midface fractures.

Fractures of the middle portion of the facial skeleton are commonly referred to as midface or LeFort fractures. While significant progress has been made in terms of evaluation and treatment of such fractures, they remain a challenge for the maxillofacial surgeon. In this section, we will review the principles of midface fracture evaluation and repair, emphasizing the importance of understanding biomechanics and controversies that exist in respect to repair sequencing.

Dental Occlusion↗

Common craniofacial anomalies: conditions of craniofacial atrophy/hypoplasia and neoplasia.

The spectrum of craniofacial malformations includes conditions of congenital and acquired etiology. The conditions of craniofacial atrophy and hypoplasia may arise primarily or secondary to previous therapeutic interventions. The conditions of progressive hemifacial atrophy (Romberg disease) and radiation-induced hypoplasia will be reviewed on the basis of their etiology, pathogenesis, anatomy, and treatment. Approaches to the surgical management of these conditions will be discussed. The craniofacial neoplastic conditions of fibrous dysplasia, neurofibromatosis, and craniofacial tumors will also be reviewed and discussed.

Adolescent↗

Severe nasal clefting and abnormal embryonic apoptosis in Alx3/Alx4 double mutant mice.

A group of mouse aristaless-related genes has been implicated in functions in the development of the craniofacial skeleton. We have generated an Alx3 mutant allele in which the lacZ coding sequence is inserted in-frame in the Alx3 gene and the sequences encoding the conserved protein domains are deleted. Mice homozygous for this null allele are indistinguishable from wild-type mice. Compound mutants of Alx3 and Alx4, however, show severe craniofacial abnormalities that are absent in Alx4 single mutants. Alx3/Alx4 double mutant newborn mice have cleft nasal regions. Most facial bones and many other neural crest derived skull elements are malformed, truncated or even absent. The craniofacial defects in Alx3/Alx4 double mutant embryos become anatomically manifest around embryonic day 10.5, when the nasal processes appear to be abnormally positioned. This most probably leads to a failure of the medial nasal processes to fuse in the facial midline and subsequently to the split face phenotype. We detected a significant increase in apoptosis localised in the outgrowing frontonasal process in embryonic day 10.0 double mutant embryos, which we propose to be the underlying cause of the subsequent malformations.

Animals↗

Tcof1/Treacle is required for neural crest cell formation and proliferation deficiencies that cause craniofacial abnormalities.

Neural crest cells are a migratory cell population that give rise to the majority of the cartilage, bone, connective tissue, and sensory ganglia in the head. Abnormalities in the formation, proliferation, migration, and differentiation phases of the neural crest cell life cycle can lead to craniofacial malformations, which constitute one-third of all congenital birth defects. Treacher Collins syndrome (TCS) is characterized by hypoplasia of the facial bones, cleft palate, and middle and external ear defects. Although TCS results from autosomal dominant mutations of the gene TCOF1, the mechanistic origins of the abnormalities observed in this condition are unknown, and the function of Treacle, the protein encoded by TCOF1, remains poorly understood. To investigate the developmental basis of TCS we generated a mouse model through germ-line mutation of Tcof1. Haploinsufficiency of Tcof1 leads to a deficiency in migrating neural crest cells, which results in severe craniofacial malformations. We demonstrate that Tcof1/Treacle is required cell-autonomously for the formation and proliferation of neural crest cells. Tcof1/Treacle regulates proliferation by controlling the production of mature ribosomes. Therefore, Tcof1/Treacle is a unique spatiotemporal regulator of ribosome biogenesis, a deficiency that disrupts neural crest cell formation and proliferation, causing the hypoplasia characteristic of TCS craniofacial anomalies.

Animals↗

Merkel cell carcinoma with bone metastasis: a case report.

A case of Merkel cell carcinoma with bone metastasis is described. The patient, who had a history of Merkel cell carcinoma of the skin in the right cheek, had spontaneous pain in the right thigh. At the initial visit, the right hip range of motion was slightly limited, but there was no gait disturbance or abnormality in the radiographs of the right hip. However, the pain gradually increased and caused gait disturbance. The patient underwent surgical treatment. A bipolar type of femoral prosthesis was implanted into the femur, and sampling of cancellous bone was performed at the time of osteotomy. Pathological examination showed the findings of Merkel cell carcinoma. Merkel cell carcinoma is a rare malignant tumor of the skin, which usually occurs on the head, neck, or extremities and metastasizes to the lymph nodes. Although osseous involvement often occurs in the adjacent facial bones through direct invasion, distant osseous metastasis appears to be extremely rare.

Aged↗

Craniofacial growth in a whole rat head transplant: how does a non-functional head grow?

To evaluate factors intrinsic to the regulation of craniofacial bone growth, we have developed a new experimental model in which the whole head of an infant rat is transplanted to the body of an isohistogenic rat by means of microvascular anastomosis. In our model, the transplanted head has neither scars nor any moving soft tissue that could modify growth around facial bones. Using this model, we evaluated the growth pattern of the craniofacial complex by means of serial roentgenographic cephalometrics. Ten transplantations were performed using 10-day-old rats as donors and 8-week-old rats as recipients. Cephalograms were taken from the lateral direction at 10, 20, 30, and 40 days after transplantation. Several reference points were selected to analyze the growth pattern. In the present study, we conclude that the size and form of the bony complex are mainly determined genetically. There is craniofacial skeletal growth in the absence of muscle function and brain growth. Further, both the nasal cartilage and the sutures appear to be autonomous growth centers having intrinsic growth potential. Genetic or epigenetic information plays an important role at the skeletal level, but it also affects the muscles through the medium of the muscular tonus responsible for posture and other related phenomena.

Anastomosis, Surgical↗

Modified facial translocation technique to prevent necrosis of bone graft.

OBJECTIVE: To assess the efficacy of a modified facial translocation technique in preventing translocated facial bone graft from necrosis, which is the most common complication of facial translocation. STUDY DESIGN: Prospective. METHODS: A lateral nasal flap was preserved and transposed to resurface the inner surface of the translocated facial bone graft in a facial translocation approach to skull base tumors in 35 patients including 24 patients with radiation therapy between July 1998 and December 2000. RESULTS: Only one patient had bone graft necrosis. Thirty-four (97%) of 35 patients had intact mucosa covering the inner surface of the translocated facial bone graft. The outcome was not affected by preoperative or postoperative radiation therapy. CONCLUSIONS: A modified facial translocation technique using a lateral nasal flap to resurface the inner defect of the translocated facial bone graft significantly improved the viability of the translocated facial bone graft, especially in patients who underwent radiation therapy. The use of a lateral nasal flap does not interfere with the detection of early local recurrence.

Adolescent↗

Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients.

Thirteen cases of high condylar fracture treated by open reduction and fixation with miniplates were monitored for an average of 18 months postoperatively. Satisfactory functional results were achieved clinically in all but one patient. Radiologically, however, signs of condylar resorption and osteoarthrosis were diagnosed in all patients. In four patients with associated multiple fractures of the facial bones, rapid complete resorption of the condyle was observed. These changes were markedly more severe than those observed in our previous study, in which osteosynthesis was performed by transosseous wiring and subsequent intermaxillary fixation for 3 to 7 weeks. Indications for rigid and nonrigid fixation in the surgical treatment of condylar fractures are discussed.

Adolescent↗