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PubMedDate not supplied

Developmental temporal bone anatomy and its clinical significance: variations on themes by H. F. Schuknecht.

Fifty-eight fetal and neonatal temporal bones were studied to evaluate the mechanisms of development of the hiatus of the facial canal, hypotympanic fissures, periotic duct, tympanomeningeal fissures, and fetal inner ear vascularity. These were correlated with the clinical pathologic entities of temporal bone trauma, glomus jugulare tumor extension within the temporal bone, CNS-temporal septic conduits, and inner ear vascularity. Temporal bone developmental anatomy and histopathology provide rich sources of information on which to base the scientific and clinical study of otology.

Adult↗
PubMed2002

The timing of orthodontic treatment.

The time at which orthodontic treatment should be started remains a matter of conjecture. Anomalies of dental development and functional problems tend to be addressed in the mixed dentition, while definitive treatment tends to be delayed until the late mixed dentition to maximize growth potential and patient compliance. However, some clinicians advocate starting treatment earlier in certain types of malocclusion. In this article, the current concepts of early treatment, both physiological and psychological, will be explored and the relevant indications and contraindications discussed.

Adolescent↗
PubMedDate not supplied

[Skeletal corrective surgery in the visceral cranium].

Developments of recent decades have resulted in a system of high quality, low relapse osteotomies of the visceral skull and neighboring structures of the neurocranium, which offers almost unlimited, although partially complicated, surgical possibilities. However, as in other medical disciplines, there is the danger that enthusiasm for what is feasible might induce surgeons to go beyond what is necessary. A realistic assessment of the patient benefit therefore must be the basis for indication and implementation more than ever.

Adult↗
PubMed2004

Muscle influence on postnatal craniofacial development and diagnostics.

The postnatal craniofacial development is determined by exogenous and endogenous factors that may result in morphological and functional muscle changes and influence the dentoskeletal region in terms of a physiologic or dysgnathic development. Using functional appliances, efforts are made to treat skeletal malocclusions through targeted exercise and to prevent an undesirable development of the dentition and the craniofacial structures. However, the success of the treatment and the stability of the outcome are not always adequate. To illustrate the treatment processes, clinically relevant measures for diagnosing muscle function and morphology have been developed in recent years. Electromyographic investigations and bite-force measurements show an excessively high variability and the histologic examinations applied to date are restricted in their suitability for analysis of the human masticatory muscles. Animal experimental studies have meanwhile succeeded in simulating functional jaw orthopedics and in demonstrating muscle remodeling processes at the genetic level. Despite some invasiveness, the time and the small quantity of muscle tissue involved permit molecular biological measuring in the orofacial system.

Animals↗
PubMed2002

Comparative long term post-treatment changes in hyperdivergent Class II Division 1 patients with early cervical traction treatment.

This was a retrospective study of 45 Class II Division I hyperdivergent patients treated in the mixed dentition with cervical traction and an incisor biteplane. The interjaw or "B" angle (mandibular plane to palatal plane angle) was used to determine hyperdivergency. The treated sample was subdivided into 2 groups reflecting whether the mandibular or palatal plane contributed the greatest amount to the more than 1 standard deviation of the "B" angle from the mean value of the "B" angle present in the 89 untreated Class I controls. Complete records including lateral cephalometric head films were acquired at the start of treatment and 18 to 91 months after discontinuing all retention. Null hypotheses were designed to determine if any significant changes in the "B" angle, mandibular plane angle, or palatal plane angle occurred in the control group or the treated group. Thirty-two angular, linear, and proportional data were accumulated to determine the presence or absence of significant differences. The only significant angular differences found were in the group in which the palatal plane inclination was increased relative to Frankfort Horizontal. In this group, the palatal plane became more nearly parallel to Frankfort Horizontal than in the control group, and showed an increase instead of a decrease in the Y-axis. Proportional and linear data indicated the palatal plane change was a lack of descent of Posterior Nasal Spine while the descent of Anterior Nasal Spine was equal to that of the control group. The increase in the Y-axis was not the result of bite opening, but a lack of mandibular horizontal development as indicated by less of an increase in the Facial Angle. Of the 45 patients, only 4 (9%) required 2 phases of treatment and 1 of those required extraction. Thirty patients (67%) completed treatment with alignment and retraction of the maxillary anterior segment and 11 (24%) had additional alignment of the mandibular anterior segment.

Analysis of Variance↗
PubMed2005

Short-term treatment effects produced by the Herbst appliance in the mixed dentition.

This prospective clinical investigation evaluates the dentoalveolar and skeletal cephalometric changes produced by the Herbst appliance during treatment of mixed dentition patients with Class II division 1 malocclusion. Thirty individuals (15 male and 15 female individuals; initial mean age nine years 10 months) were treated with the Herbst appliance for a period of 12 months. For comparison, the records of 30 untreated Class II children (15 boys, 15 girls; initial mean age nine years eight months) were followed without treatment for a period of 12 months. The results indicated that the treatment effects produced in the mixed dentition patients were primarily dentoalveolar in nature. The mandibular incisors were tipped labially, and the maxillary incisors were retruded; a significant increase in mandibular posterior dentoalveolar height occurred, and there was a restriction in the vertical development of the maxillary molars. There was no difference in the forward growth of the maxilla between the two groups. In comparison with the controls, however, the Herbst treatment produced a modest but statistically significant increase in total mandibular length. This increase in total mandibular length, however, was less than that observed in adolescent Herbst patients in other studies.

Cephalometry↗
PubMedDate not supplied

Developmental integration in a complex morphological structure: how distinct are the modules in the mouse mandible?

The mouse mandible has long served as a model system for studying the development and evolution of complex morphological structures. We used the methods of geometric morphometrics to reassess the hypothesis that the mandible consists of two separate modules: an anterior part bearing the teeth and a posterior part with muscle attachment surfaces and articulating with the skull. The analyses particularly focused on covariation of fluctuating asymmetry, because such covariation is due exclusively to direct interactions between the developmental processes that produce the traits of interest, whereas variation of traits among individuals also reflects other factors. The patterns of fluctuating asymmetry and individual variation were only partly consistent, indicating that developmental processes contribute differentially to variation at different levels. The results were in agreement with the hypothesis that the anterior and posterior parts of the mandible are separate develop-mental modules. Comparison of all alternative partitions of the landmarks into two contiguous subsets confirmed the hypothesis for the location of the boundary between modules but also underscored that the separation between them is not complete. Modularity is therefore manifest as the relative independence of parts within the framework of overall integration of the mandible as a whole-it is a matter of degrees, not all or nothing.

Analysis of Variance↗
PubMed1992

Growth and development in orthodontics.

The recent literature on growth and development of the face and dentition includes important articles about assessment of growth, maturation, growth in the vertical dimension, treatment effects, experimental growth, and craniofacial anomalies. An underlying theme can be detected in these reports--the individuality of the child and his or her response to treatment. Central trends can be determined from growth data, but these generalizations should be applied with caution. When formulating treatment goals and planning mechanics, great variability can exist among growing children.

Adolescent↗
PubMedDate not supplied

Dentofacial growth and development.

Theoretical growth and development, and practical aspects are explored in an overview of how growth has been considered by investigators and clinicians during the past twenty years, to the beliefs held today. Diagnostic and treatment methods, where technical innovations are the most apparent, are considered in the context of classical orthodontic thinking. New diagnostic techniques will be introduced that will require changes in our basic understanding of growth and treatment. Orthodontics will continue to be integrated into total patient diagnosis and treatment.

Adolescent↗
PubMed1990

[Tooth and jaw development in the Silver-Russel syndrome].

The symptoms of Silver-Russel syndrome are described using two cases. Special attention was paid to the development of the teeth and the jaws. The typical microretrognathism is accompanied by a frontal crowding especially in the lower jaw. It is possible to adjust it to a regular occlusion using functional orthopedic appliances. Noticeable is the high degree of caries in the first dentition. Paramorphiae are not ascertainable. Etiologically, the submucosal cleft palate, which was diagnosed for the first time, would suggest an intrauterine disturbance in the eighth to the tenth week of pregnancy.

Adolescent↗
PubMed2004

A re-evaluation of the premaxillary bone in humans.

The discovery of the premaxillary bone (os incisivum, os intermaxillare or premaxilla) in humans has been attributed to Goethe, and it has also been named os Goethei. However, Broussonet (1779) and Vicq d'Azyr (1780) came to the same result with different methods. The first anatomists described this medial part of the upper jaw as a separate bone in the vertebrate skull, and, as we know, Coiter (1573) was the first to present an illustration of the sutura incisiva in the human. This fact, and furthermore its development from three parts:-(1) the alveolar part with the facial process, (2) the palatine process, and (3) the processus Stenonianus-can no longer be found in modern textbooks of developmental biology. At the end of the nineteenth and in the early twentieth century a vehement discussion focused on the number and position of its ossification centers and its sutures. Therefore, it is hard to believe that the elaborate work of the old embryologists is ignored and that the existence of a premaxillary bone in humans is even denied by many authors. Therefore this re-evaluation was done to demonstrate the early development of the premaxillary bone using the reconstructions of Felber (1919), Jarmer (1922) and data from our own observations on SEM micrographs and serial sections from 16 mm embryo to 68 mm fetus. Ossification of a separate premaxilla was first observed in a 16 mm embryo. We agree with Jarmer (1922), Peter (1924), and Shepherd and McCarthy (1955) that it develops from three anlagen, which are, however, not fully separated. The predominant sutura incisiva (rudimentarily seen on the facial side in a prematurely born child) and a shorter sutura intraincisiva argue in this sense. The later growth of this bone and its processes establish an important structure in the middle of the facial skull. Its architecture fits well with the functional test of others. We also focused on the relation of the developing premaxilla to the forming nasal septum moving from ventral to dorsal and the intercalation of the vomer. Thus the premaxilla acts as a stabilizing element within the facial skeleton comparable with the keystone of a Roman arch. Furthermore, the significance of the premaxillary anlage for the closure of the palatine was documented by a synopsis made from a stage 16, 10.2 mm GL embryo to a 49 mm GL fetus. Finally the growth of the premaxilla is closely related to the development of the human face. Abnormal growth may be correlated to characteristic malformations such as protrusion, closed bite and prognathism. Concerning the relation of the premaxillary bone to cleft lip and palate we agree with others that the position of the clefts is not always identical with the incisive suture. This is proved by the double anlagen of an upper-outer incisor in a 55 mm fetus and an adult.

Anatomy↗
PubMed1979

Myofacial pain dysfunction: a manifestation of the short-face syndrome.

The practitioner who treats patients with MPD should be aware that certain anatomic variations may predispose a patient to developing the syndrome. We feel that the newly described entity, the short-face syndrome, is such an example. Patients exhibiting short-face syndrome are overclosed. Their condition appears to be improved by establishing an increased vertical dimension of occlusion. This is first accomplished with the use of a processed acrylic resin occlusal splint. If a patient has been asymptomatic at the new occlusal relationship, a maxillary osteotomy is recommended to achieve a more permanent functional and cosmetic result.

Face↗
PubMed2004

Facial growth of adults with unoperated clefts.

Studies of adult patients with unoperated complete unilateral cleft lip and palate indicate that there is normal potential for maxillary growth. The maxilla in the unoperated patient is normally positioned or protruded. The protrusion of maxilla in the unoperated adult cleft patient is limited to the non-cleft side, contributing to hemifacial maxillary prognathism. Surgical scar tissue is known to interfere with the growth of the midface. Palatal surgery has more significant influence on the growth of the mid-face than the lip surgery; therefore, it is important to reduce the effect of surgery by delaying the timing of palatal surgery or changing the location of the surgical scar from the sutural areas. Delaying palatal surgery until the maxillary growth is complete is desirable but could lead to poor speech development. Therefore, it is essential to perform the palatal surgery before speech development. The other variables that affect the midface are the development genetic make-up of the cleft child, the amount of tissue deficiency, timing of surgery, surgical technique, and the skill of the surgeon. Surgeries continue to have some inhibitory effect on maxillary growth, but it is essential to recognize and perform those surgical procedures that have the least effect on growth of the maxilla. This will help minimize extensive orthodontic treatment and eliminate major secondary orthognathic surgery for correction of the abnormal growth of the maxilla.

Adult↗
PubMed1996

Orbital dysmorphology in unilateral coronal synostosis.

Unilateral coronal synostosis (UCS) produces overt craniofacial dysmorphology. UCS surgery in infancy aims to release the osseous restriction and normalize the fronto-orbital deformity. The quantitative effect of this surgery on the orbit and its contents is unknown. This study was conducted to quantify the preoperative orbital dysmorphology and its surgical outcome in patients with unilateral coronal synostosis. Twenty-eight UCS patients had preoperative three-dimensional computerized tomographic (CT) scans (at mean age 4.0 months), cranio-orbital reconstructive surgery (at 4.7 months), and postoperative scans (at 18.1 months). The CT data were analyzed using a computer workstation and AnalyzeTM biomedical imaging software. Four measurements were performed on both ipsilateral (same side as synostosis) and contralateral (opposite to synostosis) orbits of each scan: orbital index (OI, 100 x height/width of orbit), orbital cavity volume (OV), ocular globe volume (GV), and ventral globe Index (VGI, 100 x globe volume ventral to the anterior surface of orbital cavity/GV). The data were analyzed for statistical significance using Student's ttest. Preoperatively, the OI was significantly greater on the ipsilateral than on the contralateral side (113.7 vs. 87.3). There was a significant improvement on both sides of the orbit postoperatively, with ipsilateral 99.1 and contralateral 92.1. However, the difference between both sides remained significant. The OV was smaller in the ipsilateral orbits both pre- and postoperatively, with ipse/contralateral ratios of 95.8 and 95.2, respectively. Importantly, the GV was consistently smaller in the ipsilateral orbits preoperatively, with an ipse/contralateral ratio of 93.3. The ratio increased to 97.1 postoperatively, a statistically significant change. In the ipsilateral orbits, the preoperative VGI was significantly greater. The VGI improved postoperatively. These data indicate that UCS affects the development of the osseous orbit as well as its soft-tissue contents. After cranio-orbital surgery, there is diminution of asymmetry of both the bony orbit and its soft-tissue contents. Partial normalization of orbital dysmorphology occurred during the first postoperative year. UCS surgery in infancy does not prevent growth of orbital hard or soft tissues, and it seems to permit normalization of previously impaired growth.

Cephalometry↗
PubMed1998

[Improved treatment of cleft lip and palate is now available].

When cleft lip and palate treatment was introduced at Gothenburg in 1957, the procedure used was early bone grafting (EBG). By 1965, EBG had been omitted from the regimen, bone grafting being postponed until the appearance of mixed dentition. Analysis of the results of both techniques showed maxillary retrusion of different degrees. Accordingly, this routine was abandoned in 1975, being replaced by a procedure which is characterised by delayed closure of the hard palate (DCHP). Thus, the surgical procedure comprised the following steps: 1, lip closure at 1-2 months of age; 2, soft palate repair at 6-8 months; 3, final lip-nose surgery at 12 months; and 4, closure of the left in the hard palate, and bone grafting to the alveolar process during mixed dentition at about 8-10 years of age. Follow-up has shown the majority of patients to manifest acceptable speech development during childhood, though problems may occur in some cases. Maxillary growth has been found to be improved after DCHP, and at present the need of maxillary advancement surgery has been reduced to approximately 5% of cases, as compared with the former rates of 50% of cases among those treated with EBG, and of 25% among those treated with the vomer flap procedure.

Adolescent↗
PubMed1990

Concepts of occlusion: Australian evidence.

Longitudinal studies of aboriginal children over a 20-year period have drawn attention to the wide variation in morphological features of the dentition and the way in which occlusal relationships develop. This paper summarizes some important determinants of optimal occlusal development, namely, tooth size relationships within and between dentitions, the patterns of alveolar growth, and tooth migrations during the transition from primary to permanent teeth and the nature of growth changes in the dental arches. Dental occlusion constantly changes throughout life in response to changing functional requirements. Observations limited to cross-sectional material provide an incomplete, and sometimes misleading, concept of dental occlusion and masticatory function.

Adult↗
PubMed2004

Orofacial development in children with Down's syndrome 12 years after early intervention with a stimulating plate.

BACKGROUND: Orofacial regulation therapy for children with Down's syndrome was introduced to Europe in Munich in 1978. Since then, many clinical studies have provided scientific evidence that this therapeutic approach enhances the orofacial function and facial appearance of children with trisomy 21. Only few long-term results have been published to date. PATIENTS AND RESULTS: In the present study, 20 children with trisomy 21 were examined more than 12 years after starting treatment in infancy with a Castillo Morales stimulating plate. The follow-up examination showed that the improved orofacial appearance resulting from the early treatment had remained stable in most cases. Although the mechanical stimulus of the stimulating plate was absent during the follow-up period, some patients revealed a lip and tongue posture superior to that recorded at baseline. CONCLUSION: According to the results of the present study, the orofacial status in early childhood is decisive for the subsequent development of the orofacial region and the long-term stability of the achieved improvements: Children with a pronounced orofacial dysfunction showed a greater stimulation-plate-induced improvement than those with initially moderate orofacial findings. This observation was confirmed by the findings of the 12-year follow-up: Children with Down's syndrome and initially slight orofacial impairment displayed only slight improvements or unchanged findings.

Adolescent↗
PubMed2003

Effects of therapy on dentofacial development in long-term survivors of head and neck rhabdomyosarcoma: the memorial sloan-kettering cancer center experience.

PURPOSE: To describe potential effects of multimodality therapy on dental and facial development in long-term survivors of head and neck rhabdomyosarcoma. PATIENTS AND METHODS: The medical records of all patients aged 20 years or less presenting between 1985 and 1996 with a diagnosis of rhabdomyosarcoma and treated by protocol were reviewed. Head and neck rhabdomyosarcoma patients who were followed in the Dental Service and were alive and free of disease with at least a 5-year follow-up were included in the review. Ten patients satisfied the inclusion criteria and form the basis of this report. The median age at diagnosis of the 10 patients was 4.3 years (range 10 months to 19.5 years). All patients were treated with chemotherapy, two patients underwent surgery, and all but one patient received external beam radiation therapy. RESULTS: Clinical or radiographic dentofacial abnormalities were observed in 8 of the 10 (80%) patients. Abnormalities included enamel defects, bony hypoplasia/facial asymmetry, trismus, velopharyngeal incompetency, tooth/root agenesis, and disturbance in root development. Bony hypoplasia and disturbance in root formation were the most common findings. CONCLUSIONS: Multimodality therapy for head and neck rhabdomyosarcoma can result in dentofacial abnormalities that affect the patient's quality of life. The care of the long-term survivor requires a multidisciplinary approach, including early involvement of the dental team.

Adolescent↗