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PubMed1993

The interaction between soft tissues and the sagittal development of the dentition and the face.

The purpose of this study was to investigate whether there are relationships between the cross-sectional surface area (CSSA) of the lips and the sagittal structure of the skeletal parts of the face and the dentition in the midsagittal plane and whether the sagittal structure of the face and the dentition is related to the class of malocclusion. The CSSA of the upper and lower lip was measured with a planimeter on the lateral cephalograms of 156 patients before their orthodontic treatment with a closed lip relation in rest. They were divided into 18 groups according to their age, sex, and Angle classification. The Quick Ceph program (Orthodontic Processing, Chula Vista, Calif.) was used to digitize and analyze 23 dental and skeletal parameters. The parameters were tested by an analysis variance to show differences between the three classes of malocclusion. The regression analysis was used to look for relations between the CSSA and the skeletal or dental parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Effect of timing and method of closure of isolated cleft palate on development of dental arches from 3 to 6 years of age.

Development of the dental arches from 3 to 6 years of age was followed in 120 children with isolated cleft palate (ICP) and in 50 non-cleft (NONC) children. In 60 of the ICP children the palate had been repaired at the age of 1.8 years (SD = 0.2) and in the other 60 at the age of 1.1 years (SD = 0.1). In both groups the one-stage soft and hard cleft palate closure had been performed using the mucoperiosteal palatal V to Y push-back technique (Veau-Wardill-Kilner) or the Cronin modification. The purpose of this study was to compare the effect of the two different ages and the two different methods of palatal repair on the development of dental arches. The growth increment in maxillary canine and molar width, and posterior palatal height during the 3-year period was greater in the group with late palatal repair. In children with no secondary palatal repair, when the primary repair had been done with the V to Y method, the increase in maxillary canine width was greater than with the Cronin modification. On the other hand, when the V to Y technique was used, velopharyngoplasties were more frequent. The means of maxillary canine and molar width decreased in children with velopharyngoplasties, and increased in the others. Dental arches of ICP children were significantly smaller than those of NONC children, and the discrepancy increased during the period from 3 to 6 years of age, and increased more in the maxilla than in the mandible.

Age Factors↗
PubMedDate not supplied

Facial growth and development in unilateral complete cleft lip and palate from palate surgery up to adulthood.

Mixed longitudinal and cross-sectional roentgen-cephalometric data were used for studies of the growth and development of the face in unilateral complete cleft lip and palate from the time of primary palatoplasty up to adulthood. The results were compared with the data obtained in controls at the age of 5 years and in adults. The vertical growth of the upper and lower face exceeded its sagittal growth. The lower face showed a higher growth rate in both directions than did the upper face. The depth of the maxilla showed the lowest growth rate. The height of the upper lip increased very little as well. The most important deviation in facial development consisted of the deficient growth of maxillary depth and the prolongation of the lower face. Both these deviations develop predominantly after palate surgery and the former resulted in a gradual retrusion of the maxilla, a flattening of the face, and impairment of sagittal jaw relations. The reduction of upper face height, the posterior position of the maxilla, and the shortening of the mandible (both of the body and ramus) represented, on the contrary, early changes. The a persisting posterior rotation of the mandible, changes in the shape of the mandible, and vertical disproportion of the face increased with age, the steep slope of the mandibular body remaining at the level ascertained in early childhood. An improvement in the occlusion of incisors was obtained prior to the age of 12 years, but it regressed during the period of puberty. The prominence of the upper lip gradually decreased and the lip was short.

Adolescent↗
PubMed1990

Effect of airway obstruction upon facial growth.

This article explores both sides of the controversy concerning respiratory behaviors and dentofacial development. The literature is replete with statements that airway impairment alters facial and dental growth, but there also is substantial evidence to the contrary. Much of the confusion stems from the subjective criteria frequently used in defining the terms impairment and mouth breathing. Additionally, respiratory mechanics have often been viewed simplistically rather than in the realistic sense of a complex regulation/control system. Unfortunately, lack of objectivity may lead to an incorrect diagnosis and even worse, inappropriate treatment. Newer respirometric techniques offering more quantitative assessment of respiratory behaviors are now providing more relevant information and more objective definitions of airway impairment and mouth breathing. More recent findings suggest that nasal-oral breathing per se is not necessarily harmful to growth. However, in instances when the nasopharyngeal or oropharyngeal airspace is small, exaggerated postural responses in obligatory nasal-oral breathers may be detrimental to growth.

Adolescent↗
PubMed1981

Three-dimensional approach to analysis and treatment of hemifacial microsomia.

Based on our experience with 40 patients with hemifacial microsomia (first and second branchial arch deformity), we have developed a three-dimensional analytic approach to the skeletal deformity. The sagittal plane x-ray views (lateral cephalogram and panorex) demonstrate the anatomy of the temporomandibular joint as well as the shape and height of the mandibular rami. The frontal plane is demonstrated by the anterio-posterior (A-P) cephalogram, which shows the discrepancy in ramus height and the abnormal arc of mandibular rotation toward the affected side. The transverse plane is evaluated with a submental vertex radiograph, which shows the shape of the mandibular body and medial displacement of the temporomandibular joint. Three-plane radiographic analysis demonstrates the total anatomic distortion and the abnormal growth vectors. We hypothesize that abnormal mandibular growth is of primary importance in this deformity. Application of this analysis has influenced the timing of intervention and the design of corrective procedures.

Adult↗
PubMed1988

The role of nasal airway obstruction in sinus disease and facial development.

Allergic rhinitis in children is often complicated by bacterial sinusitis, which can lead to chronic illness and dysfunction. Sinus disease manifests differently in children than in adults, with cough, rhinorrhea, and middle ear disease being common and pain, headache, and fever being uncommon. Sinusitis may exacerbate asthma, and as many as 70% of children with allergy and chronic rhinitis have abnormal findings on sinus x-ray studies. Nasal cytologic specimens showing large numbers of polymorphonuclear cells with intracellular bacteria are also evidence of sinusitis. Obstruction of the nasal airways by allergic rhinitis or enlarged adenoids can lead to deviations in facial growth, specifically increased facial length. With the removal of the obstruction and a return to nasal breathing, facial length may become more normal. Sinusitis in children is treated with antibiotics, usually for 3 to 4 weeks, to eliminate the infection. Adjunctive therapy with antihistamines, decongestants, cromolyn, and corticosteroids may also be helpful. Topical steroids, such as flunisolide and beclomethasone, can be very useful in pediatric patients. These steroids decrease edema and prevent the release of allergic mediators that may be responsible for an environment favoring the bacterial infection causing sinusitis.

Airway Obstruction↗
PubMed1992

Long-term effects of Herbst treatment in relation to normal growth development: a cephalometric study.

The aim of this study was to evaluate the short- and long-term effects of Herbst appliance treatment in relation to normal growth and development. The sample consisted of 32 subjects (16 boys and 16 girls) with a Class II, division 1 malocclusion treated successfully with the Herbst appliance for an average period of 7 months. The patients were reinvestigated 6 months post-treatment when the occlusion had settled and at the end of the growth period, an average of 6.7 years (SD = 1.1 years) after therapy. The control group comprised of 32 subjects (16 boys and 16 girls) with excellent occlusion (Bolton Standards). Sagittal, skeletal, and dental changes occurring during three observation periods were evaluated on lateral cephalograms in centric occlusion. On a long-term basis, Herbst treatment improved the sagittal jaw base relationship, but did not normalize it. The sagittal dental arch relationship, on the other hand, was almost normalized.

Activator Appliances↗
PubMed1993

A coordinate-free approach to the analysis of growth patterns: models and theoretical considerations.

Developmental biology holds keys to our understanding of morphological pattern formation whether these patterns are expressed in the fossil record or among extant species. Though much is known about osseous growth at the cellular level (e.g. Hall, 1991), we have minimal understanding of the coordinated processes that combine to produce a complex, three-dimensional form. We have proposed a framework for the coordinate-free representation of form, a statistical method for comparing and modelling growth trajectories for complex morphologies, and a means for the eventual elucidation of the role of growth in the evolution of morphology. Our method uses the coordinate locations of biological landmarks to represent form as a matrix of all possible linear distances between landmarks, the form matrix. When two forms are expressed in this way, comparison of these forms is accomplished by computing the ratios of like linear distances, the form difference matrix. When the forms being compared are from a growth series, the matrix of ratios is called a growth matrix. Patterns of growth for two groups can be compared by computing the growth difference matrix. We applied growth difference matrix analysis to the study of sexual dimorphism of ontogeny in the M. fascicularis craniofacial skeleton. Growth matrices describing growth in male and female M. fascicularis were presented along with the growth difference matrix that describes sexual dimorphism of growth to underscore the detailed information available from this analytical technique. The method is quite general and can be applied to two- or three-dimensional data sets of landmark coordinates (cross-sectional or longitudinal) collected from almost any developing structure. The methods that we propose enable us to go beyond a mathematical summary of the comparison of forms and the comparison of growth patterns. We provide examples of how growth patterns might be used in the study of phylogenetic relationships. Our plans for use of this method in the study of evolutionary change assumes that morphological change in the craniofacial skeleton results from evolutionary change in developmental units (as defined by Atchley & Hall, 1991) that underlie morphological structure. We believe we have the basic tools to ultimately propose informed phylogenies based solely on developmental data. This task requires the identification of 'growth features' and the polarization of these features as primitive or derived. It is also advisable to determine a set of primitive growth features for the groups of interest. This will necessitate the inclusion of outgroups in our growth analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

Growth and aging of facial soft tissues: A computerized three-dimensional mesh diagram analysis.

The normal growth, development, and aging of facial soft tissues was studied by three-dimensional (3D) computerized mesh diagram analysis. The 3D coordinates of 50 soft-tissue landmarks were collected from 591 healthy white northern Italians (351 males, 240 females) 6-40 years of age. For each gender and age class, mean values were computed, and a standardized mesh of equidistant horizontal, vertical, and anterior-posterior lines was constructed. Within each age group, male meshes were superimposed on female meshes. For each gender, the 6-year-old reference mesh was superimposed on the reference mesh of each age group. The global (size plus shape) difference was evaluated by calculating the relevant displacement vectors for each landmark. Consequently, a size normalization was carried out and the shape difference was evaluated by calculating new relevant displacement vectors for each landmark. Growth and development were different along the three spatial planes: the largest increment was observed in the vertical dimension, with major modifications in the soft-tissue profile. The vertical dimension in males increased even after 30 years of age: ear dimensions increased, trichion moved superiorly and posteriorly, and pogonion, menton, and gonion moved anteriorly and inferiorly. In all age groups, size-standardized shape differences were found in the forehead, lower-third facial profile, eyes, cheeks, and ears. In each age class, male dimensions were larger than female dimensions. During childhood, gender differences in size were limited; shape differences were even less manifest. Overall, the profile was more anterior and inferior, the gonia were more inferior and more lateral, the forehead was more anterior, and the ears were larger in males than in females of corresponding age.

Adolescent↗
PubMed1985

A comparison of craniofacial growth in normal and cleft palate rhesus monkeys.

In an attempt to better understand the etiology of middle ear disease in humans with cleft palate, a rhesus monkey model was developed. In this study, the model was extended to deal with the specific problem of otitis media in infants with cleft palate. Fifteen rhesus monkeys, Macaca mulatta, were utilized in the present investigation. Soft palate clefts were surgically produced in ten of the subjects, and five served as unoperated controls. Longitudinal data on middle ear status and craniofacial growth were collected until an approximate age of 2 years. Comparisons of linear regression coefficients representing size and rates of growth of craniofacial dimensions were made between operated and control group animals. No significant (p less than .05) differences were found between the groups. It is concluded that surgically produced clefts of the soft palate alter middle ear function and produce ear disease but do not change the rates of growth of the measured components of the craniofacial complex.

Animals↗
PubMed1997

Applicability of interceptive orthodontics in the community.

The term interceptive orthodontics used in this paper is defined as the prompt treatment of unfavourable features of a developing occlusion categorized as local factors, crowding and displacements of the mandible in closing from the rest position. The aims of the study were to determine the best age or ages for interceptive orthodontics, to establish diagnostic cut-off points for self-correcting features of the developing occlusion which can be quantified, to investigate the reproducibility of treatment decisions and to make an initial estimate of the percentage of children suitable for interception. Based on material in the Belfast Growth Study, maximum or minimum measurements associated with spontaneous correction of quantifiable features were determined and incorporated into a disposable plastic gauge. Using the gauge, the available records of 278 Growth Study subjects at age 9 years and 272 at age 11 years were assessed for suitability for interception. Most of the conditions for interceptive treatments were present at age 9 years, but others were not present until 11 years. The majority of treatment decisions were highly reproducible. Approximately 50 per cent of the children in the Growth Study would have benefitted from interceptive orthodontics. A follow-up community study seems justified.

Age Factors↗
PubMed1976

The effects of orthopedic forces on the craniofacial complex utilizing cervical and headgear appliances.

1. A three-dimensional anatomic model of a human skull was produced with birefringent materials for photoelastic analysis. By means of photoelastic techniques during application of high-pull and cervical extraoral traction, stresses were visualized within the model. 2. Extraoral anchorage affected the position of the maxillary molar and its resulting alveolar development. Cervical headgear had a much greater tipping effect on the maxillary molar than did the high-pull headgear. Both appliances examined could produce stresses which may be transmitted to distant eraniofacial sutures. As opposed to high-pull traction, cervical pull in general stressed more areas and to a much greater degree. 4. The pterygoid plates of the sphenoid bone, the zygomatic arches, the junction of the maxilla with the lacrimal bone and the ethmoid, and the maxillary teeth were affected by both types of headgear. 5. Only cervical traction produced stresses at the frontal process of the maxilla and the Zygomaticofrontal suture. 6. There were two findings which had not been previously reported: First, cervical traction tended to open the palate in the posterior region. Second, high-pull traction produced compressive stresses at the junction of the right and left maxillae inferior to the anterior nasal spine.

Facial Bones↗
PubMed1996

The morphologic structure of the openbite in adult Taiwanese.

Anterior openbite (AOB) is an intricate occlusal problem. Treatment of AOB is one of the most challenging tasks in orthodontics. An ethnic-specific norm for craniofacial skeletal patterns would be valuable in diagnosing and treating patients with AOB. To establish this norm for the people of Taiwan, a cephalometric study was conducted using the quadrilateral analysis developed by DiPaolo. The sample consisted of 15 males and 25 females in their 20s and 30s. The patients were randomly selected and were diagnosed with AOB. Various craniofacial skeletal patterns were measured, and these measurements were compared with values taken from a group of normal Taiwanese as well as with published values from a hyperdivergent group of westerners. The results support the following generalizations: (1) The growth pattern of subjects in the AOB group is hyperdivergent. (2) Both the maxillary and mandibular corpora of subjects with AOB are shorter than those of normal subjects. (3) The sagittal angle, average lower facial height, and the maxillary and mandibular sagittal ratio of subjects with AOB are larger than those of normal subjects. Abnormalities in the maxillomandibular complex causing changes in the vertical dimension of facial patterns are involved in AOB.

Adult↗
PubMed1994

Palatal changes after lip surgery in different types of cleft lip and palate.

This study concerns palatal development during 6 months following primary lip closure. The sample consisted of 75 children with different forms of cleft lip and palate and 51 noncleft children. The palate was measured at 3 months of age, just before lip surgery, after surgery at 6 months, and again at 9 months of age. The results showed that lip closure has a strong effect in the anterior alveolar region. This effect was restricted to 3 months after surgery. The changes in complete clefts were more explicit than in incomplete cleft forms. Furthermore, the data showed that arch depth reduction due to lip surgery was compensated for by continued anteroposterior palatal growth. Early orthopedics appeared to prevent major palatal collapse immediately after lip surgery. Finally simultaneous closure of the alveolar cleft at the nasal side resulted in continued reduction of anterior cleft width.

Case-Control Studies↗
PubMed1998

Thoughts on the early treatment of Class II malocclusion.

The timing of Class II, division 1 malocclusion treatment is discussed in the context of the development of the dentition within the craniofacial environment. The occlusion of the dentition actually serves as the key that controls and maintains the exact position of the mandible vis-à-vis the maxilla during childhood, pubescence and throughout adulthood. Research and clinical evidence suggest that treatment which 'disturbs' the interdigitation of teeth in the Class II malocclusion can lead to correction of the distocclusion. This correction can theoretically be undertaken throughout childhood and adolescence, and even thereafter. Treatment at a very young age was thought to normalize the occlusion, and consequently the growth process, leading to more stable results. Re-examination of this concept shows that, for practical purposes, the presence of the first premolars signals an early indication for treatment of Class II, division 1 malocclusion. The mobility of the deciduous second mandibular molars provides the last opportunity to prevent, whenever possible, a four premolar extraction approach.

Adolescent↗
PubMed1982

Dento-facial orthopaedics in the correction of class II malocclusion.

An orthopaedic appliance system has been developed with the specific therapeutic intention of removing those factors responsible for the initiation or maintenance of the skeletal Class II malocclusion. This is accomplished by means of restraint and redirection of forward maxillary growth and induction of mandibular growth. Concurrently, adverse soft tissue influences are eliminated or ameliorated. Clinical and experimental evidence gives support to this concept and case histories show that clinical mode of use of the appliance system. An initial 10--12 month orthopaedic phase is followed by a second phase of similar duration, utilizing full Edgewise therapy to perfect the occlusion. The second phase is much reduced in complexity and is generally confined to alignment and final detailing as the essential corrections have been achieved in the orthopaedic phase. It is considered that this combined approach to Skeletal II treatment is more physiologic than conventional treatment and results in a better harmony of dental and facial features.

Adolescent↗
PubMed1989

Facial growth after treatment of unilateral temporomandibular joint ankylosis in childhood without growth centre transplantation. A serial cephalomorphometric study.

Our aim was to study the influence of early surgical treatment of temporomandibular joint ankylosis on further facial growth and development. At the Department of Maxillo-Facial Surgery, Zurich, 11 children with a unilateral TMJ-ankylosis met the criteria of a maximal preoperative interincisal mouth opening of 15 mm, of a minimal long-term postoperative interincisal mouth opening of 30 mm, and of excellent documentation. 30 anatomical landmarks were defined on the copies of the follow-up cephalograms using the structure-superimposition technique. The points were perforated and digitized. Analysis and graphic-plotting were followed by computer. The hypothesis that mandibular growth continues once the ankylosis was successfully treated (without transplantation of a growth centre) and mandibular function definitely restored, was confirmed. The treatment does normalize the growth rate, but it seems that abnormal growth patterns cannot be influenced by it. As a consequence, the surgical release of the ankylosis should be performed as early as possible.

Adolescent↗
PubMed1984

The influence of the trigeminal nerve on facial growth and development.

For the past twenty years it has been argued that the growth of the face is governed by the growth of a variety of contiguous soft tissues and functioning spaces (functional matrices). Recently, extensive data have been marshalled to suggest that the growth of the functional matrices is controlled by "trophic" influences from nerves. Accordingly, the present study sought to evaluate the role of the trigeminal nerve in the regulation of facial growth by placing unilateral stereotaxic lesions in the trigeminal nerve (root, ganglion, or major sensory branch) of the 10- to 20-day-old rat. The unoperated side and a number of sham animals served as controls. In all, 323 operations were performed, with 119 animals surviving until the age of 50 days. The location and extent of the lesions were controlled histologically. Cephalometric analysis revealed subtle but statistically significant distortions of the facial skeleton; however, the magnitude of the effect was quite small. Thus, although a modest case can be made for the contention that the trigeminal nerve exerts a trophic influence on the craniofacial complex, the conclusion that trophic effects constitute a major factor in the regulation of craniofacial growth cannot be supported.

Animals↗