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PubMed1991

Vertical facial growth: a longitudinal study from 7 to 14 years of age.

Multilevel analysis is used to describe the changes in vertical facial dimensions and their relationships in Dutch girls between 7 and 14 years of age. For the anterior face height (nasion-gnathion) and the posterior face height (sella-gonion) a fourth degree polynomial was fitted. The mandibular plane angle (sella nasion-gonion gnathion) could be described with a second degree polynomial. Low correlations were found between the growth parameters (intercept and age coefficient) of the anterior and posterior face height, which points to independent growth and development of the anterior and posterior face height. The individual length and growth velocity (at age 10.8) of the anterior face height and the mandibular plane angle showed substantial correlations. It was concluded that changes during growth with regard to the mandibular plane angle are more strongly related to the anterior than to the posterior face height.

Adolescent↗
PubMed2000

The effect of muscle transplantation after unilateral partial facial paralysis on craniofacial growth and development: relationship between muscle and nerve histomorphometric findings.

Muscle transplantation has become an indispensable tool to restore the smile in patients with long-standing or congenital facial paralysis. However, little is known of the effect of this surgical intervention on craniofacial growth and development or of the adaptation of the transplant to its recipient site under circumstances of growth. The present study investigates these phenomena in the rabbit model. Twelve-day-old New Zealand White rabbits were randomly assigned to three experimental groups. The control group was used to study normal craniofacial growth and development (n = 15). In the nerve ablation group, unilateral paralysis of the buccal branches of the facial nerve was surgically induced (n = 15). In the transplant group, the surgically induced unilateral paralysis of the buccal branches was immediately followed by a neuromuscular graft (n = 12). All animals were operated on at the age of 12 days, and follow-up evaluations were performed at the ages of 2 months and 6 months. Computerized dorsoventral roentgencephalometric and computed tomography investigations were performed at both ages. Nerve and muscle histomorphometric measurements were performed at the age of 6 months to relate the quality of nerve and muscle regeneration to the growth parameters. The roentgencephalometric measurements revealed that analogous disturbed parameters were present in the nerve ablation and the transplant groups. However, in the transplant group, an additional significant effect of time between 2 and 6 months was seen for some parameters. This resulted in significant differences between the nerve ablation and transplant groups at 6 months for these parameters. Computed tomography measurements showed no significant differences in maxillary or mandibular volume in the transplant group compared with the control or nerve ablation groups. However, a significantly diminished increase in bone volume existed in the transplant group for the time period between 2 and 6 months in comparison with the control and nerve ablation groups. Muscle histomorphometric findings revealed a significant change in muscle fiber composition in the graft compared with the normal latissimus dorsi muscle; this was due to a major decrease in type IIB fibers, with an increase in type I and type IIA fibers. Compared with the normal zygomaticoauricular muscle, the amount of type I fibers was significantly increased. No fiber atrophy was found. Macroscopically, the transplanted muscle failed to increase its length during growth. Nerve histomorphometric findings demonstrated a normal amount of nerve fibers; however, they had significantly decreased diameters and reduced myelin areas. The nerve histomorphometric parameters were related to the muscle histomorphometric findings, which in turn were related to craniofacial growth disturbances. These findings suggested that the main growth differences between the transplant group and the control group may have been due to altered nerve function influencing muscle function. Scar tissue formation and the development of more intense muscle activity later are suggested as the causes of the additional effect of time between 2 and 6 months for the several parameters in the transplant group. Reasons for the failure of complete conversion of the graft to a fast muscle and the failure of the transplant to elongate during growth are discussed.

Animals↗
PubMed1987

Surgical treatment of the jaw deformities in hemifacial microsomia.

The surgical treatment of the mandibular and maxillary deformities in patients with hemifacial microsomia requires some form of mandibular lengthening. This is usually either via ramus interpositional bone grafting or end-on bone grafting. In a few cases, ramus lengthening may be completed by a sagittal split. Once the mandible has been reconstructed, the maxillary surgery can be completed. In previous forms of treatment, mandibular bone grafting was completed without regard to function and neuromuscular adaptation and a significant percentage of such procedures completed failed. Egil Harvold and his colleagues developed a method by which changes in form and function are co-ordinated by using a functional appliance resulting in neuromuscular adaptation. After the bone grafting is completed, as the second of six phases of treatment, a specially designed registration bite-block further facilitates neuromuscular adaptation by controlling mandibular movements (function), but in addition it protects the bone graft from excessive forces thereby aiding in osteogenesis (third phase). The theoretical basis, classification of deformities, and phases of treatment developed are presented and the surgery is described in detail. The results of a consecutive group of patients treated by these methods is then presented. While this form of treatment is not the only one possible, it is the only one that has been tested in the laboratory, proven in patient care, and stood the test of time.

Adolescent↗
PubMed2000

Dental and prosthodontic care for patients with cleft or craniofacial conditions.

Prosthodontic treatment has a long and rich history in the care of patients with cleft lip and palate. Because of increased knowledge of craniofacial growth and development and improved surgical and orthodontic treatment, today's cleft patients receive better care and in less time. This requires less prosthetic intervention. Still, prosthetics retains an important, if somewhat diminished, place in cleft care, and the prosthodontist remains an integral member of the cleft/craniofacial habilitation team. This review presents the current state of the art in dental/prosthodontic care for patients with cleft palate and related craniofacial anomalies.

Cleft Lip↗
PubMed2001

[Age-specific time course of growth of cervical vertebrae and its potential for use in the evaluation of jaw development].

A total of 370 lateral roentgenograms of the cervical part of the spine of children and adolescents of both sexes aged 6-18 years are analyzed. Time course of changes in the vertebrae is described on the basis of statistical data processing. Classification of stages in formation of vertebral apophyses is created. The authors prove impossibility of using cervical vertebrae for quantitative evaluation of the growth potential. A method for qualitative rapid diagnosis of biological age is proposed.

Adolescent↗
PubMed2005

[The study of maxillary protraction face mask combined with orthodontics for complete unilateral cleft lip and palate patients].

PURPOSE: The purpose of this study was to evaluate the influence of maxillary protraction face mask combined with orthodontics on complete unilateral cleft lip and palate patients' jaws. METHODS: 14 patients with complete unilateral cleft of lip and palate were included. Lateral cephalometric films were taken before orthodontic treatment ,before protracting and after orthodontic treatment. The statistical data were compared and analysed by SPSS10.0. Student's t test was used to determine the effect of maxillary protraction face mask combined with orthodontic treatment on jaw growth before and after treatment. RESULTS: The treatment resulted in good outcomes: incisor's overjet of 2mm, stable occlusion and straight profile. The SNA angle had a significant increase (P<0.001). The SNB angle and mandibular plane angle (SN-MP) have no change (P>0.05). The convexity of angle had significant change (P<0.001). CONCLUSION: Orthopedic force combined orthodontic treatment on patients with UCLP can promote the development of maxilla, without significant effect on the mandible. The overjet and overbite were improved by increasing the clination of upper anterior teeth, compensating lingually on lower anterior teeth and moving the upper anterior forward. The profile was improved from concave to straight, maxillary protrusion was increased, upper lip was plumpand, and the relationship between upper and lower jaws was more compatible.

Cephalometry↗
PubMed1996

Long-term effects of antineoplastic chemotherapy and radiotherapy on dental development.

Advances in treatment protocols over the past 20 years have resulted in much improved survival rates for children with cancer. As more children survive, the emphasis has moved from "saving children at all costs' to saving children "at least cost to the child' and protocols are continually reviewed with this in mind. As more dental practitioners are likely to encounter children who have survived malignant disease, this paper looks at the long-term effects of treatment modalities on the dentoalveolar complex.

Adolescent↗
PubMed1994

Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up.

This is a retrospective study of 26 patients (seven growing and 19 non-growing) who received costochondral grafts (n = 33) for construction or reconstruction of the ramus/condyle unit (RCU). Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long-term (> 1 year). Average follow-up was 48.6 months for growing and 46.4 months for nongrowing patients. Facial asymmetry and malocclusion were successfully corrected in all patients except for those with hemifacial microsomia, where partial correction was most common. For the growing patients mean change in RCU length (n = 8) during the observation period was +3.1 mm on the constructed/reconstructed side and +3.2 mm on the unoperated side. For nongrowing patients, mean change in the RCU length (n = 25) was -5.7 mm for the reconstructed side. Three patients developed lateral contour overgrowth of the articulating surface; no patients developed clinically significant linear overgrowth with malocclusion. The results of this study indicate that a costochondral graft may be used successfully to construct/reconstruct the RCU and that linear overgrowth of the graft does not appear to be a clinical problem with the method described in this paper.

Adolescent↗
PubMed1992

Growth and development of the face in complete unilateral cleft lip and palate during prepubertal and pubertal periods.

Roentgencephalometry was used for the assessment of the growth and development of the face during prepubertal and pubertal periods in children with complete unilateral cleft lip and palate treated with the same methods. The first series included 16 boys and 15 girls, the second series consisted of 15 boys and 15 girls examined repeatedly at the beginning and at the end of the follow-up period. There were no definite differences in the growth rate of the face between the two periods of age. Therefore, the deterioration of overjet during puberty could be due to the depletion of the compensation and adaptation mechanisms after the previous orthodontic treatment rather than to the enhanced growth rate. As compared to other facial dimensions a lower growth rate showed during both periods the length of the anterior base, the depth of the maxilla and in particular the height of the upper lip. Developmental changes of variables of shape and position proceeded similarly during both periods of age. An exception represented the rotation of the mandible and the inclination of upper incisors. During the prepubertal period the lower jaw showed a very slight posterior rotation, while during puberty an anterior growth rotation was present. A rapid improvement of the proclination of upper incisors was attained only during the prepubertal period. It was accompanied by an improvement of overjet. However, during the period of puberty there was a renewed deterioration of overjet. A marked retrusion of the maxilla developed already in the prepubertal period. During both periods occurred an identical impairment of sagittal jaw relations and of the upper lip prominence, accompanied by a flattening of the facial profile and reduction of the nasolabial angle. The prominence of the nose increased, the angle of the cranial base remained unchanged. Intersexual differences were not demonstrated in any studied characteristics.

Adolescent↗
PubMed1996

Orthodontic treatment in the mixed dentition.

In the mixed dentition, the goal of orthodontic treatment is to maintain or improve arch integrity for the eruption of the permanent teeth, and to prevent the development of a more complicated malocclusion. The importance of correct diagnosis prior to the treatment of mixed-dentition patients cannot be over emphasized. An understanding of the mixed dentition's normal development allows clinicians to determine if the occlusion is developing outside of the normal range. Appropriate treatment can only be planned after this determination has been made. Once it is concluded that orthodontic treatment is required, decisions must be made regarding the timing of treatment, the specific type of treatment needed, and the provider of treatment. By employing a systematic approach to examination and treatment planning, the general dental practitioner can provide an important service to patients with a mixed dentition.

Child↗
PubMed1994

An improved method for airway assessment in children.

Respiratory mode determination using the simultaneous nasal and oral respirometric technique (SNORT) or a head-out body plethysmography can be time-consuming, expensive, and intimidating to children. We have developed an improved method for assessing respiratory mode that uses inductive plethysmography linked to a menu-driven computer program that circumvents some of these problems. An assessment of 29 subjects over as many as nine separate time points suggests that respiratory mode measurements remain fairly uniform in some children, but can vary significantly in others.

Airway Resistance↗
PubMed1998

The effects of myotonic dystrophy and Duchenne muscular dystrophy on the orofacial muscles and dentofacial morphology.

This article takes a closer view of two of the less rare myopathies, myotonic dystrophy (MyD) and Duchenne muscular dystrophy (DMD). A high prevalence of malocclusions was found among the patients affected by these diseases. The development of the malocclusions in MyD patients seems to be strongly related to the vertical aberration of their craniofacial growth due to the involvement of the masticator, muscles in association with the possibly less affected suprahyoid musculature. Thus, a new situation is established around the teeth transversely. The lowered tongue is not in a position to counterbalance the forces developed during the lowering of the mandible by the stretched facial musculature. This may affect the teeth transversely, decreasing the width of the palate and causing posterior crossbite. The lowered position of the mandible, in combination with the decreased biting forces, may permit an overeruption of the posterior teeth, with increased palatal vault height and development of anterior open bite. The development of the malocclusions in DMD patients also seems to be strongly related to the involvement of the orofacial muscles by the disease. However, the posterior crossbite is not developed owing to the narrow maxillary arch, as is the case in MyD patients. On the contrary, the posterior crossbite in DMD is due to the transversal expansion of the mandibular arch, possibly because of the decreased tonus of the masseter muscle near the molars, in combination with the enlarged hypotonic tongue and the predominance of the less affected orbicularis oris muscle.

Biomechanical Phenomena↗
PubMedDate not supplied

Positional changes of the upper canine and posterior teeth, hard palate, and sinus floor from primary to permanent dentition.

This cross-sectional study investigated normal positional changes of the upper permanent canine and posterior teeth, hard palate, and sinus floor in normal Taiwanese children from the deciduous to early permanent dentition. In total, 261 panoramic radiographs were used. During the observation period, almost all structures changed their positions toward the distal and occlusal direction. The vertical positional changes of crowns of all teeth were greater than those of the root apices through all developmental stages. There were small positional changes in the mesial surfaces of the crowns of the upper buccal teeth until their roots had formed. There were continuous positional changes in the crowns and root apices of the permanent molars during tooth development and eruption. There were no significant changes in tooth inclination for any of the buccal teeth, whereas there were conspicuous changes in tooth inclination for the permanent molars. The floor of the maxillary sinus remarkably changed its position in an occlusal direction during the active eruption period of the first molar and buccal teeth.

Adolescent↗
PubMed1978

A growth-related concept for skeletal class II treatment.

The use of a combined activator--high-pull headgear appliance for treatment of Class II, Division 1 malocclusion is presented as a preliminary report. The activator itself is equipped with a palatal bar, lower lip pads, and torque-control auxiliaries for the upper incisors. The face-bow is mounted directly on the activator, and the extraoral force vector is equivalent to that of an anterior high-pull vector. During bite registration the veritcal displacement of the mandible is restricted to a minimum, and the anterior displacement should not exceed 6 mm. On the basis of current knowledge of the growth of the bony facial structures, treatment objectives and a specific approach for skeletal Class II correction are defined. Following these objectives, the therapy aims at correcting the malocclusion without diverting the anterior landmarks of the bony face from their specific lines of growth. This is brought about by the corresponding mechanics of the activator-headgear combination. The corrective effect of this appliance may be assumed to be the result of several different factors. The maxillary dentition is restrained in a posterior cranial direction, and an inhibitory effect on the maxilla counter to its line of development is attained. The mandibular dentition is influenced in an anterior downward direction by means of the bite registration, and the occlusion is unlocked during treatment. Any transfer of distally directed headgear forces from the maxilla to the mandible is prevented. Temporary stimulation of condylar growth, possibly combined with temporary posterior deflection of condylar growth, may also be induced. In this way it is possible to take maximum advantage of condylar growth in the sagittal dimension. Thus, not only is the malocclusion corrected but, at the same time, decisive profile improvement is achieved by anterior development of the mandible. From the experience gained so far with a Class II, Division 1 sample undergoing treatment with the activator-headgear combination, it would appear that skeletal control of the direction of facial growth during treatment is possible. A quantitative report on this group of approximately forty patients, some of whom are still receiving treatment, is in preparation.

Activator Appliances↗
PubMed1978

Mandibulo-facial aspects of the cervical cystic lymphangioma (cystic hygroma).

Sixteen cases of cervical cystic lymphangioma are reported; all but two were present at birth. Intra-oral extensions were detected in five and three of these caused macroglossia resulting in partial respiratory obstruction. Mal-development of the jaws and consequent dental malocclusion is a possible complication of the condition. In planning the treatment of such patients, maxillo-facial surgeons and orthodontists should be consulted at an early stage. The treatment of choice is complete excision, but where vital structures are involved repeated sub-total excisions are advocated.

Child↗
PubMed1983

The development and significance of septal and dental deformity from birth to eight years.

The septa of a series of 145 babies at birth was assessed into 3 types: type A--in the midline, type B--unilateral bending or kinking at the vomerine junction, type C--deformed to both sides. These were reassessed aged 5-6 years with the primary dentition present, and 90 cases reassessed aged about 8 years. In some there was a change to types B and C, but none changed to type A. Of 15 cases of external deformity of the nose at birth, 10 (66%) had irregularity of the columella. The children had dental examination and plaster casts made, an ear, nose and throat examination, and were photographed. The chances (which were statistically significant) of developing dental abnormalities and malocclusion, palatal asymmetry, upper respiratory tract infections and ear disease were found to be mostly in type B cases, less in type C cases and least in type A cases. Thus ear troubles were found in 45% type B, 25% type C and only 10% of type A cases. The palatal height was not related to any septal deformity.

Australia↗
PubMed1998

Pediatric mandibular fractures.

Over the last 20 years, a revolution in the management of facial fractures has taken place. Refinements in biocompatible materials of great delicacy and strength along with advances in our understanding of biomechanics of the face, have rendered complex injuries consistently amenable to accurate 3-dimensional reconstruction. Furthermore, with the availability of education in the techniques of internal rigid fixation, these advanced techniques have become routine practice in adults. However, the suitability of rigid internal fixation for children remains controversial. There are many concerns about the effect of implanted hardware in the mandible of a growing child. In addition, some evidence suggests that the elevation of functional matrix off of bone may result in alterations in development. The goal is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. However, in children the treatment of bony injuries is most easily accomplished by techniques that may adversely effect craniofacial development. While it is not entirely possible to resolve this dilemma, there exists an extensive body of experimental and clinical information on the appropriate management of pediatric mandibular fractures which can be used to formulate a rational treatment plan for most cases. This paper presents an overview of the contemporary understanding and application of these treatment principles.

Adolescent↗
PubMed2000

Construction for the modern head: current concepts in craniofacial development.

The vertebrate head is a highly complex composite structure whose morphological characteristics are controlled at the level of the gene. There is now increasing evidence for the role of gene families that encode transcription factors in determining the embryonic plan of the developing craniofacial complex. These genes act as regulators of gene transcription being intimately involved with the control of complex interactions between multiple downstream genes. Combinatorial expression of the Hox genes (a family of highly conserved master regulatory genes related to the homeotic genes of the fruitfly Drosophila) have been shown to play a definitive role in patterning distinct regions of the craniofacial complex. In the vertebrate, Hox genes pattern the hindbrain and branchial regions of the developing head up to and including structures derived from the second branchial arch. The first branchial arch and more rostral regions of the head are patterned by groups of homeobox genes more diverged from the original Hox clusters. Transgenic mice, with targeted disruptions in many of these genes, are now providing insights into the molecular mechanisms that lie behind a number of craniofacial defects seen in man.

Animals↗