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The alveolar flap for the repair of the cleft alveolus -- related to the development of the upper jaw.

A new method for the repair of the cleft alveolus employing the alvolar flap, was carried out in 33 patients with a unilateral total cleft. Alternating primary osteoplastic repairs were performed in in aqual number of patients. The postoperative interval varies between 8 and 9 years. The patients were followed up with attention beng paid to the further growth of the upper jaw.

Alveolar Process↗

Features of maxillary arch and nasal cavity in infancy and their influence on deciduous occlusion in unilateral cleft lip and palate.

The purpose of this study was to test the statistical relationship between certain preoperative characteristics of the maxilla and nasal cavity and later occlusal development in patients born with complete unilateral cleft lip and palate. The sample consisted of 51 patients and 22 of them had undergone surgical treatment which included vomer flap and pushback palatal repair, while the remaining 29 patients were treated with a routine characterized by delayed closure of the hard palate. Twelve variables related to 4 different maxillary and nasal areas were recorded from maxillary casts and frontal cephalograms obtained in infancy. Crossbite scores and maxillary intercanine width were determined from dental casts taken at 3 years of age. Multiple linear regression analysis showed that the preoperative variables selected as predictors of maxillary development at the age of 3 did not explain more than half of the variation found in our subjects. Also, the predictors were not the same in the two surgical subgroups. To improve our ability to predict, further variables should be tested and, if possible, added to the regression formulae.

Child, Preschool↗

The effect of growth hormone therapy on craniofacial growth and dental maturity in children with Down syndrome.

Craniofacial growth was evaluated 3 years after termination of growth hormone (GH) therapy in ten Down syndrome (DS) children. The control group consisted of 16 age-matched children with DS. The treatment started at 6-9 months of age, and the duration was 36 months. There were no statistically significant differences in craniofacial development between DS children treated with GH or DS children not treated. In conclusion, the results of this study indicate that GH therapy for 36 months in children with DS did not change the craniofacial morphology compared to a group of DS children not given GH.

Cephalometry↗

Teratogenic effects of alcohol and isotretinoin on craniofacial development: an analysis of animal models.

The teratogens alcohol and isotretinoin cause different patterns of facial dysmorphogenesis in the human. For isotretinoin the pattern is consistent with interference with the normal development of the cranial neural crest, particularly that destined for the second visceral arch. In vitro studies in the rat indicate that, at threshold levels of exposure to isotretinoin, the development of the second arch crest represents the most sensitive process of organogenic development. For alcohol, the facial abnormalities result from exposure very early in development, during the gastrulation process. There is no evidence that this is a peculiarly sensitive stage of development with respect to alcohol; animal studies indicate that other processes in the organogenic period are equally or more vulnerable. The emphasis given to the abnormal facial features in the fetal alcohol syndrome is considered a phenomenon associated with the exclusivity of syndromes.

Animals↗

The Roberts syndrome.

The Roberts syndrome appears to follow an autosomal recessive mode of inheritance. The cause of the abnormalities probably exerts its effect prior to the seventh week of gestation and only on a few organ systems undergoing development during this time. The peculiar morphologic features of metaphase chromosomes of the one individual who has been studied extensively are unexplained.

Abnormalities, Multiple↗

Four measurements for assessing facial deformity.

Four lateral cephalometric measurements which localize the anterior maxilla and chin in the horizontal and vertical planes are presented and evaluated against three control methods, in a pilot study of 40 patients. It was found that in 27 out of 30 comparisons (90%) the frequency of agreement between the proposed and each of the control methods was greater than the agreement between the control methods themselves. In three out of 30 comparisons (10%) it was found that the frequency of agreement between the proposed and the control methods was the same as between the controls themselves. In addition, there was a greater agreement reached between methods when measurements were related to the cranial base. In view of the close relationship between cranial and facial development, it was considered that measuring ratios should portray the facial deformity not just in relation to the cranial base but to the individual's own cranial base and not to a population norm. The results also confirm the findings of previous work in the literature which demonstrate disagreement between cephalometric methods for localization of a given landmark.

Adolescent↗

Facial growth and morphology in long-term survivors after bone marrow transplantation.

A roentgen cephalometric investigation was used to study facial growth and morphology in 17 children who had undergone bone marrow transplantation (BMT) because of acute leukaemia and aplastic anaemia. The ages at BMT varied from 1.0 to 12.9 years. Preoperative treatment included high doses of cyclophosphamide and in children with acute leukaemia also 10 Gy total body irradiation (TBI). The median observation period following BMT was 3.9 years. The control group comprised 85 age and sex matched healthy children. In comparison to the controls, all linear measurements studied were found to be significantly diminished in children conditioned with TBI. For variables describing vertical dimensions, the degree of reduction appeared to be associated with the patients' ages at the time of irradiation. It was concluded that the disturbance in dental development, which is also a consequence of TBI, could be partly responsible for this association. Children who were not conditioned with TBI exhibited no significant differences when compared to controls in respect of the variables studied.

Bone Marrow Transplantation↗

Maxillary hypoplasia secondary to midfacial trauma in childhood.

Three normal children who suffered midfacial trauma and developed midfacial retrusion that would require Le Fort III advancements for correction of the deformity are described. The common denominator in these three cases seems to be an injury to the medial facial structure including the nasal septum. It is concluded that midfacial fractures in childhood may be a cause of subsequent midfacial hypoplasia.

Adolescent↗

A cephalometric study of young marmosets (Callithrix jacchus).

Linear and angular measurements of young marmosets taken at three-month intervals from a series of cephalograms are presented. They show that linear craniofacial development was largely complete by six months of age, subsequent angular changes being mainly related to dental development. No sexual dimorphism was apparent, and there was substantial homogeneity in results for animals of the same age. Thus, marmosets, with their low cost, ease of handling, and rapid maturation, may provide a useful animal model for craniofacial research.

Age Factors↗

Normal and abnormal development of the lip and palate.

Largely because fusion of the lip and the palate are developmental weak points, common facial clefts may arise in a great many ways, both experimentally and in man. However, we believe that the vast majority of human clefts have similar origins with minor variations. One must always question the appropriateness of animal models. Apparently appropriate animal models are giving us considerable insight into the manner in which genetic and environmental factors alter development and how they interact with one another in the developing embryo. These studies help us understand the nature of the multifactorial threshold concept as it applies to cleft lip and cleft palate, and they emphasize the potential importance of even "minor" environmental factors in determining on which side of the threshold for clefting an individual embryo may fall.

Animals↗

Growth and development in patients with untreated clefts.

Motivated by the observation that individuals with clefts of the lip and palate exhibit different facial growth than those individuals without facial clefts, many studies have assessed dentofacial morphology in order to understand these differing growth patterns. This review addresses current understanding of facial growth in patients with untreated clefts, drawing broad conclusions about the state of the art, and presents a challenge for cleft care in the future.

Cephalometry↗

Eruption Guidance Appliance effects in the treatment of Class II, Division 1 malocclusions.

The objective of this research was to cephalometrically evaluate the possible effects of the Eruption Guidance Appliance on the craniofacial complex in a sample of 30 patients, over a treatment period of 26 months. The experimental sample consisted of 30 patients (13 females and 17 males), 27 of which presented with a Class II, Division 1 malocclusion and 3 with a Class I malocclusion. The mean initial chronologic age was 9 years; the treatment period lasted 26 months. A control group was used for comparison and consisted of 30 subjects (13 females and 17 males) of similar ages and spanned a similar observation period. Twenty-six subjects of this control group had Class II, Division 1 malocclusions, and 4 had Class I malocclusions. Lateral cephalometric headplates were obtained for the experimental group initially and after 26 months of treatment. The subjects in the control group were randomly selected from a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric headplates were obtained annually from 4 to 18 years of age. Comparative statistics were used to assess possible differences between the experimental and control groups during the 26-month period of observation. Results demonstrated statistically significant increases in mandibular growth, degree of mandibular protrusion, lower anterior and total anterior face height, mesial migration of the lower molars, and mandibular posterior dentoalveolar height. There was also lingual tipping and retrusion of the upper incisors, linear protrusion of the lower incisors, improvement in the maxillomandibular relationship and in molar relationship, as well as a significant decrease in the overjet and overbite and an inhibition of the vertical development of the upper incisors. The study demonstrated no significant changes in maxillary growth during the evaluation period. It was concluded from these results that the effects of the Eruption Guidance Appliance during this time period were mostly dentoalveolar, with a smaller, but significant, skeletal effect.

Cephalometry↗

Dentofacial development in long-lasting nasal stenosis.

In 18 patients with congenital choanal atresia the connection between impeded nasal respiration and dentofacial development was studied by a combined radiocephalometric and biometric method. The results obtained showed that neither the dental occlusion nor the vertical facial growth diverged from normal. The sagittal growth, however, was significantly reduced. Consequently, nasal stenosis remaining during the growth period contributes not only to transitory discomfort but seems to induce permanent morphologic alterations as well.

Adult↗

[Evaluation of mandibular propulsion appliances in children. A study of 18 cases].

PURPOSE: Mandibular propulsion appliances are used currently in the treatment of class II malocclusion. The purpose of this study was to evaluate their effects on facial development to formulate specific indications. PATIENTS AND METHODS: Eighteen children (mean age 9-12) treated with a propulsion device for a class II division 1 malocclusion with a minimum of 4 mm overjet were included in a retrospective study over a 4 year period. We compared maxillomandibular and dentoalveolar position before and after treatment using Delaire computer software cephalometric analysis and superpositions. RESULTS: Statistically significant effects on molar discrepancy (p = 0.0002), overjet (p = 0.0003), sagittal mandibular position (p = 0.0040 for FM-Me/theoretical and p = 0.0010 for NP-FM-Me), mandibular length (p = 0.004 for FM-Me/theoretical), mandibular corpus length (p = 0.0286 for Go-Me/theoretical), upper incisors palatal version (p = 0.0002), and on lower incisors lip version (p = 0.0436) were assessed. No action on maxillary growth (p = 0.7274 for FM-NP/theoretical), ramus length (p = 0.9651 for Cp-Go/theoritecal), lower facial height (p = 0.7045 for ENA-Me/theoretical) or translation of the alveolar arches (p = 0.9571 for A-Pti'/ENA-Pti and p = 0.1564 for B-Pa'/B-Pa) could be confirmed. CONCLUSIONS: An increase in mandibular corpus development and no effect on alveolar arches suggests a basal mandibular action for this device. This concludes that retromandibular position and brachycorpus with upper incisor lip version, without lower incisors lip version are the best indications for mandibular propulsion appliances. Prospective studies should be carried out to confirm this hypothesis.

Activator Appliances↗

Beautiful balanced faces. The first 9 years: the most critical time!

This article is a review of the literature presented over the past 150 years regarding the implications of airway obstructions. A practical approach is presented and directed to understanding growth and development of children from infancy through adulthood. Emphasis is placed on the first nine years of a child's life. The author believes that early intervention and control of airway obstruction will enhance the lives of children who have obstructed airways. Studies have been cited as well as cases presented verifying the authenticity of the material.

Airway Obstruction↗

[Observational study of craniofacial growth and development in Mexican children].

The election of a investigation about craniofacial growing and development in Mexican children, was done due to a lack of national information in this rubric and as a fundamental part of the "growing and development in the scholastic" module of the Universidad Autónoma Metropolitana-Xochimilco, which work hypothesis was that "craniofacial growing and development in Mexican, 6 to 12 children in Xochimilco area are due to nutritional deficiency, second dentition eruption delay and dental maloclution "which was totality confirmed in a 100 Mexican facial characteristic children field work study, with cephalometric studies which permit to determine the craniofacial growing standard. This study was corroborated with a 40 children, 4 years later follow up.

Child↗

Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities.

Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

Adolescent↗

The role of uninhibited occlusal development.

Stage A treatment is compatible with contemporary orthodontic treatment. 1. It allows for free and uninhibited occlusal development. 2. It gives the orthodontist and opportunity to make a meaningful diagnosis. 3. It does not inhibit the natural inherent forces of growth and development from expressing themselves within the individual patient. 4. It establishes the position of the lower anterior teeth by their self-alignment. 5. It enables the orthodontists to predict the stability of treatment. 6. It simplifies the treatment when Stage I commences. 7. It helps in developing a good rapport between patient, parent, and orthodontist. Just as Caesar wrote of Gaul in his day, "Omnia [Begg] divisaest in partes tres ... "--Stage I, Stage II, and Stage III. I would like to suggest that new province has been added: Stage A--it being the prelude to the accepted three stages in Begg treatment or any appliance treatment of the past.

Dental Occlusion↗