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PubMedDate not supplied

Craniofacial growth in cleidocranial dysplasia--a roentgencephalometric study.

The purpose of this study was to analyze craniofacial growth in cleidocranial dysplasia (CCD) with emphasis on bone remodeling, mandibular condylar growth, and tooth eruption. Skull radiographs of 22 CCD children followed longitudinally were examined. The span of time investigated varied for each patient, but the period from 5 years to adult age was well covered. Five patients had metallic implants inserted in the jaws; the implants enabled detailed analysis of bone remodeling, jaw rotation, and tooth eruption. In the calvaria, an open anterior fontanelle area persisted in most cases but decreased with age. A frontal sinus failed to develop or was diminutive in all cases but one. In the cranial base, the size increase of the sella turcica was reduced as a result of modest resorption at the floor and the posterior wall; the clivus was flexed in most cases, but the flexion remained stable during the observation period. Growth in maxillary height was severely reduced, primarily because resorptive lowering of the nasal floor was minimal. The amount of bone apposition on the orbital floor and the alveolar process was smaller than expected. Condylar growth direction was vertical giving rise to a forward rotation of the mandible in relation to the anterior cranial base. The expected resorptive remodeling below the mandibular angle and anteriorly on the ramus was negligible. The low maxilla, in combination with a marked forward mandibular rotation in cases with unstable occlusion as a consequence of eruption problems in the permanent dentition, gave rise to a diminished anterior facial height.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate.

OBJECTIVE: To identify and analyze quantitatively the development of the maxillary dental arch before and after cheiloplasty. DESIGN: Prospective, longitudinal study of maxillary dental arch development at age of 1, 3, 6, and 12 months. SETTING: All patients were treated at a university hospital craniofacial center. PATIENTS: Twenty-seven infants with nonsyndromic, unilateral complete cleft lip and palate. INTERVENTION: Millard's rotation-advancement cheiloplasty was performed between the ages of 3 and 4 months. RESULTS: The anterior portion of the nonclefted segment (I-G), anterior ridge length of the nonclefted segment (I-C), and anterior ridge length of the clefted segment (L-C') continuously increased from 1 to 12 months of age. The anterior cleft width (G-L), anterior arch depth (I perpendicular to CC'), anterior basal angle (angle GC-CC'), and anterior arch curature angle (angle GIC) continuously decreased after the cheiloplasty. CONCLUSIONS: Cheiloplasty could mold the anterior portion of the maxillary dental arch palatally by exerting continuous pressure.

Analysis of Variance↗
PubMed1996

A facial growth analysis based on FEM employing three dimensional surface measurement by a rapid laser device.

Although there have been several studies of finite element method (FEM) analysis on two dimensional (2D) facial growth with cephalometric X-rays, there has been little FEM analysis on three dimensional (3D) facial growth of long term observation. Therefore the objective of our study is to use FEM model by 3D surface measurement of rapid laser device from human dried skull and to analyze the changes of facial growth based on FEM by the volume and the direction of strain in each stage. Samples were taken from each human dried skull for 5 stages; about 0, 3, 6, 9, 12 and 18 years of age, a total of 6 normal human dried skulls. (No abnormal skeletal growth patterns were selected and age was supposed by tooth development and eruption.) After measuring each human dried skull by 3D rapid device, we selected the clearest 16 anatomical reference points from about 70,000 points on face image to form accurate FEM shells. The study utilized Cosmos/M (SRAC) for FEM analysis, on a PC(NEC). From the strain analyses, it was revealed that (1) The vale of growth strain from 0 to 3 years of age and from 3 to 6 years of age gradually increased from condylar area toward mental area and the most vale of growth strain was showed at mental area. The vale of growth strain of corpus area was bigger than other areas. (2) As a whole the vale of growth strain of other areas except mental, corpus and nasal area were almost equal. The results indicate especially the growth change of mandible were predominantly showed in the early stages, and the direction of growth strain changed backward and above from mental area to condylar area.

Adolescent↗
PubMed1998

Cephalometric norms in Japanese adults.

PURPOSE: Knowledge of the normal dentofacial patterns of adults belonging to various ethnic and age groups is important for clinical and research purposes. Lateral cephalometric standards of normal Japanese adults were developed using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. PATIENTS AND METHODS: Cephalometric radiographs of 217 Japanese adults were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of white American adults. RESULTS: Statistically significant differences were found in the Japanese sample, who had a shorter maxilla, larger upper anterior face height, and lower posterior dental height than Burstone's white sample. A less prominent chin was observed in the Japanese male group. Soft tissue analysis of the Japanese subjects showed a retrognathic maxilla and mandible in relation to the soft tissue glabella and bilabial protrusion when compared with the white adult standards. CONCLUSION: Lateral cephalometric norms are specific for the racial group, but these values should not be interpreted as treatment goals. Normative data represents an aid for the diagnosis and treatment planning of orthognathic surgery according to the needs and expectations of each individual patient.

Adult↗
PubMed1975

New perspectives on orientation and their benefits to clinical orthodontics - part I.

The historical development of cranial reference lines, basic to cephalometric orientation, was discussed. The evolution to, away from, and back again to the Frankfort horizontal plane for descriptive and communicative purposes as benefits to the clinical orthodontist was explained. Objectives were set forth as a basis for selecting the most appropriate method in orienting the headplate for measurement and assessment. The major functions of cephalometrics were pointed out to be its use for description or classification of the face together with the malocclusion and for superimpositioning for longitudinal comparison. Each of these purposes calls for particular requirements pointing to the need for combinations of planes and multisuperimposing. The statistical findings via a computer pointed to the use of the Frankfort plane as the most desirable basic reference for descriptive reasons. Composites also suggested good order from Frankfort horizontal when serial tracings were compared. It was emphasized that true porion was used, not the ear rod of the cephalometer. For growth analysis the basion-nasion plane was shown to be longitudinally of superior value for chin behavior.

Adolescent↗
PubMed1996

The effects of fronto-parieto-squamosal suture fusion on cranial growth: an experimental study.

Craniosynostoses have been known for at least 20 centuries, but their etiopathogeneses are still unclear. There are three main theories to explain the etiology of craniosynostosis, Moss's theory being the most popular. According to Moss, the development of the neurocranial form is viewed as an integration of the growth of the skull base, the calvarial bones, the meninges, and the enclosed brain. Experimental studies, however, are generally focused on cranial vault suture synostosis. This study aims to demonstrate the effects of cranial base synostosis by performing fronto-parieto-squamosal suture fusion. This fusion affected the whole cranial configuration. These effects were more prominent closer to the cranial vault, increasing at the anterior facial height and the lower facial length, reflected by ventral dislocation of the total face, and increasing of the kyphosis at the cranial base. It has also been demonstrated that synostosis of a junction point near the cranial base affects the vault and the base simultaneously. Any approach that tries to treat the cause, and not the symptom, of synostosis must, then, be based on an understanding of how cranial growth occurs and of how sutural growth processes are related to the totality of cranial growth.

Animals↗
PubMed2005

Changes in dentoalveolar and facial heights during early and late growth periods: a longitudinal study.

This longitudinal study examined the dentoalveolar structures during early and late growth periods in 62 subjects (26 male, 36 female) with normal facial patterns and acceptable occlusions. Hand-wrist radiographs were assessed and subjects grouped accordingly as either early stage (group 1) or late stage (group 2). Group 1 comprised 30 subjects with skeletal development maturation stages between PP2= and MP3=, H or S. Group 2 comprised 32 subjects with skeletal development maturation stages between MP3u and Ru. Skeletal and dentoalveolar measurements and ratios were assessed at the beginning and end of the observation periods. Differences in measurements and ratios within each group were examined using paired t-tests. Differences between the 2 groups were evaluated using Student's t-tests. Increases in alveolar heights (except for upper posterior alveolar heights) differed between the groups. Vertical alveolar dimensions increased substantially in group 1 in comparison with group 2. With the exception of upper anterior alveolar heights, all increases in group 2 were statistically significant. As a result of differential growth in alveolar dimensions, lower facial ratio (Co-Go/ANS-Me) and overbite remained constant in both stages. Vertical alveolar growth exhibited regional differentiation according to the pubertal growth periods. Although this growth plays a role in the establishment of normal facial patterns and occlusion, it should also be considered with respect to the treatment and treatment stability of patients showing vertical facial discrepancies.

Adolescent↗
PubMed1990

Correlation between nasal width and maxillary incisal alveolar width in post-natal facial development.

The paired nasomedial processes of the prenatal developing face contribute to the formation of the nasal region as well as the alveolar segment of the maxillary four incisors. The objective of this investigation was to determine whether or not there is a common anatomic relationship between the transverse nasal dimension and the corresponding transverse alveolar dimension that is continued in the post-natal period. The corresponding transverse dimensions were measured on a longitudinal series of 120 A-P cephalograms. In addition, A-P cephalograms of 24 dried skulls and also of 19 individuals having severe craniofacial malformations were analysed. The mean difference between the nasal dimensions and the corresponding alveolar dimensions ranged from 0.14 to 1.72 mm in the various groups. However, the statistically significant correlation coefficients between the measured dimensions were low (range r = 0.36-0.57). The developmental stage did not affect this relationship. Crowding was not found to be a major factor explaining the variability, although sex was seen as a significant factor.

Adolescent↗
PubMed1994

Histologic changes in dental morphology induced by high dose chemotherapy and total body irradiation.

Disturbances in dental development were studied with the use of radiography and histology in a patient with acute lymphoblastic leukemia who was treated with induction chemotherapy at 2.3 years of age and bone marrow transplantation at 4.3 years of age. The follow-up 9.5 years after bone marrow transplantation showed evidence of short tapered roots, enamel hypoplasia, microdontia, and aplasia. A histologic examination of two extracted permanent teeth showed that the crown of the maxillary lateral incisor exhibited numerous incremental lines that corresponded closely to the treatment periods with cytotoxic drugs. The maxillary second premolar exhibited regularly spaced incremental lines in the enamel and dentine. A gross hypoplasia was seen in the cervical part of the crown corresponding to the time of administration of 10 Gy total body irradiation. The results indicate that chemotherapy mainly induces qualitative disturbances in dentine and enamel, whereas total body irradiation induces both qualitative and quantitative changes.

Abnormalities, Radiation-Induced↗
PubMed2002

Introduction of a three-dimensional anthropometry of the viscerocranium. Part I: measurement of craniofacial development and establishment of standard values and growth functions.

BACKGROUND AND OBJECTIVE: The analysis of lateral cephalograms is based on many vague landmarks that vary intra- and inter-individually. Exposure to radiation and high-quality equipment are essential, while identical object positioning is almost impossible. Anthropometry as presented in the literature is time consuming and cannot reproduce cranial three-dimensionality. Poor landmark definitions and resilience of the soft tissue foster systematic measurement errors. We used few easily detectable and accessible landmarks that are closely related to underlying bone. The distances measured were visualized three-dimensionally. MATERIAL AND METHODS: Measurements from 540 volunteers were reconstructed. Reliability was assessed through repeated measurements. Corresponding distances were measured in lateral cephalograms taken the same day. RESULTS: The age- and sex-related mean values and 95%-percentiles were visualized as growth functions. The intra-individual relative error in anthropometry was 3.7%, in roentgenocephalometry 0.9%. The inter-individual error was 5.8% for anthropometry and 3.6% for roentgenocephalometry. CONCLUSION: Applied anthropometry as described in the paper is reliable and valid for measuring craniofacial growth, arriving at a diagnosis and 'monitoring' treatment results. The relative measurement error in anthropometry appear to be smaller than the systematic magnification and distortion found in lateral cephalograms.

Adolescent↗
PubMed2004

Le Fort I in cleft patients: 20 years' experience.

Primary surgery for cleft lip, alveolus, and palate is only the beginning of management for this condition, because the congenital malformation and the scars of corrective surgery during infancy affect the physiological development of the skeleton and the soft tissue. Once the patient has stopped growing, therefore, secondary maxillomandibular malformation is frequent in these patients. The most frequent skeletal malformations in secondary cleft lip and palate are hypoplasia and malposition in the three planes of the superior maxilla space. In these cases, combined orthodontic and surgical treatment is necessary; of the various techniques available, Le Fort I osteotomy is the one most indicated for repositioning of the maxilla. Although this technique is now standardized to correct the simple maxillo-mandibular malformation, in the case of secondary malformation in the cleft lip and palate, modifications are necessary in the surgical technique to ensure the best esthetic and functional result and to reduce the possibility of relapse. After 20 years' experience in the treatment of secondary skeletal malformation in cleft lip, alveolus, and palate, a critical review is made of the different steps of planning and performing Le Fort I osteotomy in these patients.

Alveolar Process↗
PubMed1997

Three-dimensional study of growth and development of the nose.

OBJECTIVE: The aim of this study was to describe normal nasal growth in a large sample of boys and girls from 6 to 14 years of age, to compare nasal development at 14 years of age with its adult dimensions, and to evaluate differences in growth patterns between males and females. DESIGN: Growth and development of the nose were analyzed through the three-dimensional facial morphometry method. One thousand thirteen examinations were performed on 402 children between 6 and 14 years of age and on 101 adults. Three-dimensional coordinates of five nasal landmarks were collected. Eleven parameters including nasal volume and external surface were calculated and averaged for age and sex. RESULTS: Volume, surface, and linear distances were larger in males than in females, with the exception of the 11-to-12 age group, where a sharp female growth spurt was present. In males, the growth spurt was broader, and continued to 13 years of age at a nearly steady rate. Statistically significant gender differences could be found both in the adult group and before the adolescent growth spurt. CONCLUSIONS: Our findings are in general agreement with previous reports on craniofacial growth, which suggested a strong tendency in males for growth to continue for several years beyond that seen in females.

Adolescent↗
PubMed1980

Physiologic timing of orthodontic treatment.

1. With the knowledge that certain facial bones respond in growth similarly to the growth of long bones, the hand-wrist film can be used as an indicator of the maturational status of the orthodontic patient. 2. Six stages of hand-wrist development have been advocated as guides in the timing of treatment with the stages geared to the individual patient rather than to statistical tables. 3. Stage 2 represented the important early prepubertal period when much growth was ignored but during which Class II correction could be effectively achieved without prolonged periods of mechanotherapy. 4. It was emphasized that the puberal growth spurt could be overlooked by the clinician. In addition, puberal spurt in the female may be of such a short duration that much growth may have already elapsed by the time this stage was recognized. 5. Stage 5 represented the period of residual growth during which posttreatment changes could occur. At the present state of the art these changes seem to be unpredictable but some warning may be possible with the use of the hand-wrist film taken prior to the termination of treatment. 6. The clinician is encouraged to utilize the hand-wrist film as another diagnostic aid. A few easily recognizable events can indicate the individual's maturational status.

Adolescent↗
PubMed1998

Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton, studied by the finite element method.

The aim of this study was to evaluate the biomechanical effect of rapid maxillary expansion (RME) on the craniofacial complex by using a three-dimensional finite element model (FEM) of the craniofacial skeleton. The construction of the three-dimensional FEM was based on computer tomography (CT) scans of the skull of a 12-year-old male subject. The CT pictures were digitized and converted to the finite element model by means of a procedure developed for the present study. The final mesh consisted of 2270 thick shell elements with 2120 nodes. The mechanical response in terms of displacement and von Mises stresses was determined by expanding the maxilla up to 5 mm on both sides. Viewed occlusally, the two halves of the maxilla were separated almost in a parallel manner during 1-, 3- and 5-mm expansions. The greatest widening was observed in the dento-alveolar areas, and gradually decreased through the superior structures. The width of the nasal cavity at the floor of the nose increased markedly. However, the postero-superior part of the nasal cavity was moved slightly medially. No displacement was observed in the parietal, frontal and occipital bones. High stress levels were observed in the canine and molar regions of the maxilla, lateral wall of the inferior nasal cavity, zygomatic and nasal bones, with the highest stress concentration at the pterygoid plates of the sphenoid bone in the region close to the cranial base.

Adaptation, Physiological↗
PubMed1992

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to three different regimes. Assessment of nasolabial appearance.

From extraoral photographs taken from the front and in profile of 61 16-year old children with unilateral cleft lip, alveolus, and palate (UCLAP) who had been treated by three different treatment regimes, the nasolabial appearances were assessed by a panel. The photographs were masked, leaving only the mid face including the nose and lips. The following features were assessed using a five point scale: nasal form, symmetry of the nose, vermilion of the upper lip, shape of the vermilion border, total symmetry of upper lip, and nasal profile including the upper lip. The number and type of secondary operations required were recorded. Intraobserver reliability was good but interobserver agreement was poor, some observers systematically scoring more severely than others. A panel of six was therefore set up to establish an acceptable mean assessment. The treatment regime that included secondary bone grafting, and the one that included primary bone grafting and presurgical orthopaedic-T-traction, scored better on all features assessed compared with the group that underwent primary bone grafting but no T-traction. The latter group required fewer secondary revisionary procedures, however, which could explain these results.

Adolescent↗
PubMed2003

[Treating five cases of Class III skeletal brachygnatia maxilla with the Delaire mask].

Class III skeletal abnormalities are known as sagittal defects and they are recognized by a hollow profile, which is an unesthaetical morphological distorsion often ill--accepted by the patient, a severe disability. Due to the large number of clinical patterns, it is crucial to make an accurate diagnosis. Class Ill skeletal abnormalities involving a maxillary brachygnatia are caused by an insufficient development of the jawbone. Treatment will therefore consist in boosting growth of the lower back section of the jawbone. The external device known as Delaire mask which stimulates growth of the lower back section of the jaw is particularly recommended to achieve this. This piece of research set out to assess the effectiveness of this method based on five of our patients. Outstanding results were obtained, namely alveolar ridge slided forward on the jawbone, improved profile (a cutaneous Class I is obtained), and a disappearance of the occlusion, along with a correction of the inverted backward bite. When adequately prescribed, the use of the Delaire mask, as opposed to corrective surgery, leads to a slow and gradual improvement. Furthermore, results achieved among young children blend into their own natural growth. By resorting to early treatment with the mask, it is possible to avoid falling back on complex surgery, which would almost necessarily be of the orthognatic type among adults.

Bone Diseases↗
PubMed2005

Treatment protocol for unilateral cleft lip and palate patients: questioned by two case reports.

BACKGROUND: The types and severity of clefts as well as palatal development and growth in children with repaired cleft lip and palate deformities can vary greatly. Independent of the technique used surgery produces scar tissue, which restricts palatal growth so that by the second decade many patients have an underdeveloped maxilla. Experience has shown that the maxillary retrognathism found in many cleft patients is not amenable to nonsurgical correction. Few long-term studies have evaluated the procedures, sequencing and timing of the treatment methods found to give the best results. This lack of reliable information means there is a serious gap in our ability to assess the value of different treatment modalities. AIMS AND METHODS: From the viewpoint of orthodontics, this article describes the treatment protocol used by the cleft lip and palate team at the University Hospitals of the KU Leuven. The present treatment protocol is illustrated and questioned by two cases. The roles of prediction of facial growth and distraction osteogenesis are discussed.

Alveoloplasty↗
PubMed1999

Delayed development or congenital absence of a single first permanent molar in Japanese child patients.

OBJECTIVE: Delayed eruption of the first permanent molar (M1) is a relatively rare finding. This report describes the occurrence of delayed development and eruption of a single M1 in Japanese child patients. DESIGN: Cases were identified by surveying 353 orthopantomograms taken of child patients attending a Dental Hospital. Dental age, crown morphology and the presence of third permanent molars (M3) were determined from radiographs and clinical examination. SETTING: Osaka University Dental Hospital in Japan. RESULTS: Nine cases were identified from radiographs. The occlusal morphology of the affected molars showed a reduction of the distolingual cusp. Dental ages correlated more closely to chronological ages when the affected teeth were assumed to be second permanent molars (M2) than they did when the teeth were assumed to be M1. M3 proximate to the affected molar was congenitally absent in the orthopantomograms of all affected subjects. CONCLUSIONS: It is suggested that in the cases seen here the affected teeth were likely to have been second permanent molars that had migrated mesially in association with the congenital absence of M1, although congenital absence of M1 has been reported to be extremely rare.

Adolescent↗