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PubMed2001

Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate.

Cleft lip and palate affects the child in many ways, particularly appearance, dental arch relationships, growth of the face, and speech development. The key to successful care is management in a multidisciplinary team adhering to a well-designed protocol, and careful audit of results. We present the intermediate outcome audit of 15 patients with complete bilateral and unilateral cleft lip and palate whose condition was managed in a multidisciplinary team according to a strict protocol. We give the results observations of operations of a single surgeon's functional primary surgery over a 6-year period in terms of dental arch relationships, cephalometric analyses, aesthetic assessments, and speech analysis. The results show good early facial growth, with dental arch relationships appropriate for the age and group; we found only minor speech discrepancies, with no patients requiring pharyngoplasty. The results show the importance of multidisciplinary management, the value of keeping to sound surgical protocols, and functional techniques in cleft lip and palate surgery. Our study includes the neglected group of children who have bilateral cleft lip and palate, and it conforms to the style of pan-European projects.

Cephalometry↗
PubMed2001

Analysis of Holdaway soft-tissue measurements in children between 9 and 12 years of age.

In this study, 43 lateral cephalometric radiographs from 20 boys and 23 girls subjects were used to determine the Holdaway soft tissue growth changes. Subjects with Class I occlusions, balanced skeletal profiles, normal growth and development, and no orthodontic treatment history were included in the investigation. The cephalometric measurements were carried out on the first and second radiographs of each subject, with an average interval of 5 years. The growth changes in both sexes were analysed separately. The changes resulting from growth and development were determined by a paired t-test. The results showed that all measurements were significant at various levels except for upper lip sulcus depth, subnasal-H line distance, and lower lip H distance in girls, and upper lip sulcus depth, subnasal-H line distance, H angle and lower lip H line distance in boys. The measurement differences were observed with a Student's t-test. No significant difference was found for any measurement except upper lip base thickness (P < 0.001) and upper lip thickness (P < 0.01). The following measurements during the observation period were statistically different: soft-tissue facial angle (P < 0.01 in girls, P < 0.05 boys), nose prominence (P < 0.001 in girls and boys), skeletal profile convexity (P < 0.001 in girls, P < 0.01 in boys), basic upper lip thickness (P < 0.001 in girls and boys), upper lip thickness (P < 0.05 in girls, P < 0.001 in boys), H angle (P < 0.001 in girls), lower lip sulcus depth (P < 0.001 in girls and boys), and soft-tissue chin thickness (P < 0.001 in girls, P < 0.001 in boys).

Cephalometry↗
PubMed1996

Aging of the normal nose in adults.

Like other organs, the nose changes as the body ages. A review of the literature reveals a basic understanding of the aging process in the nose but a paucity of documentation and few organized studies. This study was designed to identify systematically the agerelated changes in the normal, nondiseased adult nose. A nasal-sinus laboratory was created, and a computerized patient database was developed. Four separate investigations were conducted. First, 111 subjects ranging in age from 21 to 94 years of age were studied prospectively using 135 variables. The following data were collected: history, symptoms, physical examination, rhinomanometry, ciliary beat frequency, smell testing, and incentive spirometry. Second, photographs of a separate group of 105 subjects 20 to 86 years of age were studied to ascertain the facial cephalometric changes that occur with aging. Third, a histopathologic examination of the nasal septum was performed in 20 additional subjects to evaluate the cellular changes that accompany aging. Finally, an epidemiologic study analyzing the prevalence of various nasal complaints by age was conducted, based on a review of more than 11,000 patient charts from surgeries and office visits. A number of specific age-related changes in the nose were identified, including an increased likelihood of certain nasal complaints, a pattern of increasing airflow resistance, and a decrease in physical abnormalities in the nasopharynx. The appearance of the nose, as measured by the nasolabial angle and the height/length ratio, was also found to change with age.

Age Distribution↗
PubMed1983

Mouth breathing in allergic children: its relationship to dentofacial development.

While there are many claims that abnormal breathing patterns alter facial growth, there are limited controlled data to confirm this. We evaluated forty-five North American Caucasians of both sexes, ranging in age from 6 to 12 years. Thirty chronically allergic mouth-breathing subjects were selected from a pediatric allergy practice, and fifteen nonallergic nose breathers were selected from a general pediatric practice. Each subject underwent an intraoral clinical examination and a cephalometric radiograph analysis. Various skeletal and dental relationships were evaluated for statistical differences related to mode of breathing and age. The upper anterior facial height and the total anterior facial height were significantly larger in the mouth breathers. Angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in the mouth breathers, and their gonial angles were larger. The mouth breathers' maxillae and mandibles were more retrognathic. Palatal height was higher, and overjet was greater in the mouth breathers. Maxillary intermolar width was narrower in the mouth breathers and was associated with a higher prevalence of posterior cross-bite. Over all, mouth breathers had longer faces with narrower maxillae and retrognathic jaws. This supports previous claims that nasal airway obstruction is associated with aberrant facial growth. Longitudinal studies are needed to evaluate the effectiveness of early intervention in preventing these growth alterations.

Age Factors↗
PubMed1999

Growth changes in measurements of upper facial positioning.

Growth changes in the position of the midline upper face are examined for samples of Pan troglodytes, Gorilla gorilla, and modern humans. Horizontal and vertical distances between nasion and the anterior end of the cribriform plate are plotted against stage of dental development. Kendall's nonparametric correlations between facial positioning and stage of dental development are tested for significance. In African apes, the upper face becomes more projecting and positioned higher relative to the anterior cranial base. The extent of this horizontal and vertical separation reflects primarily facial size. In modern humans, the upper face becomes more projecting but is relatively stable in its vertical position. Comparison of Pan and modern human crania in the youngest dental age category indicates that the upper face of modern humans is positioned lower early in postnatal life. The position of the upper face (glabella) relative to the anterior and posterior cranial base is presented for several fossil hominid crania. The fossil crania are similar to Pan and modern humans in facial projection relative to the anterior cranial base. However, glabella is positioned low in the fossil crania. Total facial projection (relative to hormion) for Sts 5 is similar to the mean for Gorilla. Fossil Homo and robust australopithecine crania display very projecting upper faces. We suggest that the upper face of Homo is projecting due to the length of the anterior cranial fossa, while robust australopithecines possess a thick frontal bone.

Animals↗
PubMed1996

Frankel appliance type III: correct fabrication and case report of skeletal Class III malocclusion.

The functional Regulator was developed by Rolf Frankel of Zwickau, Germany in 1966. The Frankel appliance is used to effect changes in sagittal, transverse, and vertical jaw relationships and remove the abnormal muscle forces in the labial and buccal areas that restrict skeletal growth, thereby, providing an environment which maximizes skeletal growth. Four main types of functional regulators have been described by Frankel. They are the FR I, II, III and IV. One of these appliances, the FR-III, is used in the treatment of skeletal Class III malocclusion. This appliance is used during early mixed dentition stage to correct skeletal Class III malocclusion, characterized by maxillary skeletal retrusion and no mandibular prognathism. The correct fabrication of FR-III is required. In order to do it, one must pay attention to the following: mixing the alginate impression material in a thick consistency, optimum vestibular depth, oblique mounting of casts in the vertiiculator, minimum incisal vertical height of construction bite, sufficient working model trimming, rectangular wax relief of the occlusal margin area in the working cast and a palatal bow of 1.2 mm heavy wire. Finally one case is reported.

Child↗
PubMed2001

Considerations for orthognathic surgery during growth, part 1: mandibular deformities.

Management of the growing patient with mandibular dentofacial deformities presents a unique and challenging problem for orthodontists and surgeons. The surgical procedures required for correction of the deformity may affect postsurgical growth and dentofacial development. Further, facial growth may continue postoperatively and negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal. From individual patient characteristics, the type of deformity, and the indications for early surgical intervention, it is possible to effectively treat many cases during growth. A thorough understanding of facial growth patterns is essential, and each case needs to be evaluated individually. Surgery is often undertaken with the expectation that additional treatment, including more surgery, may be required after the completion of growth. The material presented here is based on the available research and the senior author'ss clinical experience of more than 25 years in the correction of mandibular deformities in the growing patient. Advantages and disadvantages of specific surgical techniques for correction of common mandibular deformities and pertinent age and surgical considerations are discussed. The material should be viewed as a general outline that provides broad guidelines for management of these patients. The management of maxillary deformities will be discussed in Part 2 of this article.

Adolescent↗
PubMed1999

Comparisons of facial growth in patients with unilateral cleft lip and palate treated by different regimens for two-stage palatal repair.

The aim of this study was to compare facial development, particularly growth of the maxilla, of two groups of patients with unilateral cleft lip and palate in whom palatal surgery had been done slightly differently, particularly the timing of the procedures. Two-stage palatal repair had been used at 8 (velar closure) and 102 months (hard palate surgery) at one cleft centre and at 20 and 62 months at another centre. Lateral roentgencephalograms were used to analyse the first sample of 20 patients, who were followed longitudinally from 7-16 years of age. The other group comprised 17 subjects in the same age range, who were investigated cross-sectionally, also by cephalometry. Generally, the outcome of the two surgical regimens was similar and equally satisfactory, with no evident difference in facial or maxillary morphology between the two samples. From the midfacial growth point of view, it might be questioned whether it is necessary to delay closure of the cleft in the hard palate until the mixed dentition stage as was done at the first cleft centre.

Adolescent↗
PubMed1982

Craniofacial development in the absence of muscle contraction.

The muscular dysgenesis (mdg) mutation in mice causes developmental arrest of myogenesis at the myotube stage. Stained and cleared skeletal preparations and histological sections of the heads of mdg/mdg and normal mouse fetuses were compared in order to determine the effects of the mutation on craniofacial morphology. Muscles of mastication were more severely affected than tongue muscles. Mutant crania had more domed vaults and slender zygomatic arches that were displaced dorsally. The posterior part of the dysgenic mandible was bent dorsally and compressed dorsoventrally. These shape changes may be the distorting effects of persistent cervical kyphosis. Measurements of camera lucida tracings indicated that the lengths of the total mandible, the angular cartilage and process, and the condylar cartilage and process were similar between mutant and control mice. However, the widths of the condylar and angular cartilages were greatly decreased in the mutants. Moreover, the cartilages of dysgenic mice showed no size increase between 18 and 20 days of gestation. The diminished cartilages presumably result from the absence of mechanical loading from prenatal muscle function. For both condylar and angular cartilages, normal muscle activity should produce compression along the long axis of the cartilage and bending/shearing perpendicular to the long axis. It is argued that these forces are more important in promoting growth in cartilage width than length, accounting for the selective reduction of widths in the dysgenic mutant.

Animals↗
PubMed1996

Facial development in unilateral cleft lip and palate prior to the eruption of permanent incisors after primary bone grafting and periosteal flap surgery.

Roentgencephalometric studies were carried out at the age of five years in 27 boys with unilateral cleft lip and palate after primary bone grafting, as well as in 25 boys with the same type of cleft after primary periosteoplasty and in 27 normal boys who served as a group of controls. Both series with clefts differed from the group of controls by a reduced upper face height, maxillary dentoalveolar retroinclination, posterior position of the maxilla and by the shortening of mandibular body and ramus. There was a slight reduction of maxillary depth only in the series with bone grafts. The other skeletal deviations were secondary. The soft profile showed in both series with clefts a reduction of the upper lip height and of the nasal prominence. In patients with bone grafts was recorded in addition a reduced prominence of the upper lip. A comparison of both series with clefts disclosed that primary bone grafting reduced the vertical growth of the upper face and increased the dentoalveolar retroinclination of the maxilla resulting in a larger impairment of overjet and in a more marked retrocheilia. A better prominence of the nose in the series with periosteal flap surgery was produced by the primary reposition of the nasal septum, which was not performed during osteoplasty.

Bone Transplantation↗
PubMed1998

Eruption of the permanent upper canine: a radiologic study.

The early detection of eruptive anomalies of the upper canine requires an understanding of its normal eruptive pattern. We studied this pattern in terms of upper canine inclination and its relation to the lateral incisor, on the basis of the panoramic radiographic records of 305 children aged 4 to 12 years. The study sample comprised 554 maxillary canines in the oral pre-emergence phase of eruption. Subject age, sex, inclination of the canine (CI), its relation to the lateral incisor (RCLI), and development of the lateral incisor (DLI) were evaluated. The results show that the canine erupts, increasing its inclination mesially until a maximum is reached, at about 9 years of age, after which the tooth begins to progressively upright itself. The individual variability of the degree of CI at a given age is considerable. In the initial stages, the RCLI is most commonly characterized by overlapping, a situation rarely seen in the final stages. The DLI effectively discriminates both periods, because when DLI is incomplete, more than half of the cases have an overlapping RCLI. In contrast, when the DLI is complete, this overlapping is seen in only 7% to 11% of the cases. This variable therefore increases the capacity to detect a possible eruptive anomaly at an early stage. In patients with complete DLI and overlapping RCLI, particularly when associated with other clinical signs such as the nonpalpation of the cuspid bulge in the alveolar process, the presence of dental agenesis, ankylosis, malformations, or ectopic eruptions, extraction of the primary canine is advised to prevent impaction.

Analysis of Variance↗
PubMed1991

Characteristics of masticatory mandibular movements and velocity in growing individuals and young adults.

Studies of the development of mastication in the normal growing individual have received little attention in the literature. The aim of this study was to determine whether changes in oral motor function occurred during growth. Ninety healthy individuals with normal occlusion were divided into six groups of males and females, 9-10, 13-15, and 20-22 years of age. Oral motor function, with respect to mandibular displacement and velocity, was monitored with an opto-electronic method. The results revealed that the total duration of the masticatory cycle was not influenced by age or gender. However, the time distribution between the different phases was found to be influenced by the age factor, causing a longer opening time and a shorter closing time in the adults. In mastication, both mandibular displacement and the mandibular velocity in closing were less in females. A reduction of the masticatory opening velocity and an increase in closing velocity were observed with increasing age. Physiological maturation of the masticatory system due to central and peripheral changes and functional adjustments due to changes in dentition and skeletal growth may be the underlying reasons for our findings.

Adolescent↗
PubMed1977

Research on control of craniofacial morphogenesis: an NIDR State-of-the-Art Workshop.

To assess the wide clinical ramifications of control of craniofacial morphogenesis, a State-of-the-Art Workshop was conducted by the National Institute of Dental Research at the initiative of Richard L. Christiansen, Chief of the Craniofacial Anomalies Program. In conjunction with the authors listed above, the format for the workshop was developed and participants were selected. The workshop was designed to provide an in-depth review of present knowledge and to identify future goals and directions for research on guiding, altering, and thus controlling growth and development of the cranofacial skeleton. The agenda for discussion ranged from molecular biology to clinical arts such as orthopedics and surgery. It was evident during the workshop that the mechanisms and procedures for controlling craniofacial morphogenesis must be derived from many biologic, physical, and clinical fields of knowledge. It is hoped that there will evolve an interdisciplinary clinical art which is aimed at preventing and correcting craniofacial deformities. Substantial biologic information has already been accumulated on the craniofacial skeleton. The clinical art of correcting malocclusion through mechanical forces is now applicable to the entire skull. The outstanding technical accomplishments of radical surgery in the correction of congenital craniofacial anomalies show that the needed surgical skills are now available. When these resources are combined, an area of knowledge and a clinical discipline which might be called "orthocephalics" is already identifiable. The workshop was held at the National Institutes of Health in Bethesda, Maryland, on Feb. 12 and 13, 1974. The ideas exchanged were integrated and summarized by the planning committee to produce this report.

Animals↗
PubMed1985

The Beckwith-Wiedemann syndrome: a longitudinal study of the macroglossia and dentofacial complex.

Case reports provide insights into fundamental mechanisms and also assist clinicians in treatment of similarly affected patients [Pruzansky, 1976]. The present investigation examines the natural history of the macroglossia associated with a case of Beckwith-Wiedemann syndrome (BWS) and its influence on dentofacial development. Facial skeletal growth and tongue size were assessed by analyzing cephalometric radiographs from age 2 months to 7.5 years. The data were compared with cephalometric norms and new normative data derived from 13 patients with cleft lip. The major influence of the macroglossia was protrusion of dentoalveolar structures, particularly in the lower jaw. This resulted in an anterior cross-bite in the primary dentition. In addition, an abnormally obtuse gonial angle was observed increasing the effective length of the mandible. Tongue size in BWS was generally greater than the norm, but the increase with age paralleled the mean growth curve of the tongue in the control. Over time the base of the tongue became longer and the hyoid bone moved posteriorly and inferiorly, allowing for accommodation of the tongue within the oral cavity. The changes in tongue shape and dentofacial morphology support the position that early partial glossectomy should be delayed or abandoned. In cases where tongue reduction is considered necessary, the new cephalometric normative data on tongue size provided herein can be used to establish objective criteria for such surgery.

Aging↗
PubMed2002

Elliptic Fourier analysis of facial profiles during growth and development.

The quantitative analysis of facial soft tissues is of overwhelming importance for orthodontic patients. To assess the normal age-related variations in shape, soft tissue facial profiles were studied in 96 healthy male children 3 to 11 years of age and 16 young men (age 18). Standardized left-side photographs were taken of each subject, and facial profiles were traced between trichion and cervical point. The line joining the 2 landmarks was set as the baseline, and each outline was automatically digitized and mathematically reconstructed by a 30-harmonic elliptic Fourier series expansion. The same soft tissue profile was traced and digitized from the Bolton standards of comparable age. All profiles were standardized to the same area, and shape modifications were quantified by calculating the morphologic distance between the Fourier reconstructions of each facial profile and of (1) the 18-year-old Bolton standard (MD-18) and (2) the age-related Bolton standard. Descriptive statistics were computed for each age class. On average, MD-18 was 7.23 at 3 years of age, increased between 6 and 9 years of age, and decreased hereafter, reaching 6.86 at 18 years of age. Within-group variability peaked at 8 years of age, and was minimal at 6 and 18 years of age. The current soft tissue child profiles seemed different from the profile obtained from the Bolton standards.

Adolescent↗
PubMed2000

Symphyseal fusion and jaw-adductor muscle force: an EMG study.

The purpose of this study is to test various hypotheses about balancing-side jaw muscle recruitment patterns during mastication, with a major focus on testing the hypothesis that symphyseal fusion in anthropoids is due mainly to vertically- and/or transversely-directed jaw muscle forces. Furthermore, as the balancing-side deep masseter has been shown to play an important role in wishboning of the macaque mandibular symphysis, we test the hypothesis that primates possessing a highly mobile mandibular symphysis do not exhibit the balancing-side deep masseter firing pattern that causes wishboning of the anthropoid mandible. Finally, we also test the hypothesis that balancing-side muscle recruitment patterns are importantly related to allometric constraints associated with the evolution of increasing body size. Electromyographic (EMG) activity of the left and right superficial and deep masseters were recorded and analyzed in baboons, macaques, owl monkeys, and thick-tailed galagos. The masseter was chosen for analysis because in the frontal projection its superficial portion exerts force primarily in the vertical (dorsoventral) direction, whereas its deep portion has a relatively larger component of force in the transverse direction. The symphyseal fusion-muscle recruitment hypothesis predicts that unlike anthropoids, galagos develop bite force with relatively little contribution from their balancing-side jaw muscles. Thus, compared to galagos, anthropoids recruit a larger percentage of force from their balancing-side muscles. If true, this means that during forceful mastication, galagos should have working-side/balancing-side (W/B) EMG ratios that are relatively large, whereas anthropoids should have W/B ratios that are relatively small. The EMG data indicate that galagos do indeed have the largest average W/B ratios for both the superficial and deep masseters (2.2 and 4.4, respectively). Among the anthropoids, the average W/B ratios for the superficial and deep masseters are 1.9 and 1.0 for baboons, 1.4 and 1.0 for macaques, and both values are 1.4 for owl monkeys. Of these ratios, however, the only significant difference between thick-tailed galagos and anthropoids are those associated with the deep masseter. Furthermore, the analysis of masseter firing patterns indicates that whereas baboons, macaques and owl monkeys exhibit the deep masseter firing pattern associated with wishboning of the macaque mandibular symphysis, galagos do not exhibit this firing pattern. The allometric constraint-muscle recruitment hypothesis predicts that larger primates must recruit relatively larger amounts of balancing-side muscle force so as to develop equivalent amounts of bite force. Operationally this means that during forceful mastication, the W/B EMG ratios for the superficial and deep masseters should be negatively correlated with body size. Our analysis clearly refutes this hypothesis. As already noted, the average W/B ratios for both the superficial and deep masseter are largest in thick-tailed galagos, and not, as predicted by the allometric constraint hypothesis, in owl monkeys, an anthropoid whose body size is smaller than that of thick-tailed galagos. Our analysis also indicates that owl monkeys have W/B ratios that are small and more similar to those of the much larger-sized baboons and macaques. Thus, both the analysis of the W/B EMG ratios and the muscle firing pattern data support the hypothesis that symphyseal fusion and transversely-directed muscle force in anthropoids are functionally linked. This in turn supports the hypothesis that the evolution of symphyseal fusion in anthropoids is an adaptation to strengthen the symphysis so as to counter increased wishboning stress during forceful unilateral mastication. (ABSTRACT TRUNCATED)

Animals↗
PubMedDate not supplied

[Growth of Wistar rats jaws following single dose of vincristine].

In the chemotherapy of malignant diseases the cytostatic Vincristine is often used. Since literature data showed the negative effects of Vincristine on young cells of the healthy developing tissue, only animals were used in experiment of Vincristine testing. The purpose of this investigation was to evaluate the growth of the rat's maxilla and mandible in relation to time intervals following a single dose of Vincristine. The experiment concerned 80 Wistar rats of both sexes. Experimental animals (46) were subcutaneously injected, in the neck wrinkle, a single dose of 0.1 mg/kg BW of Vincristine, on the 7th or 8th postnatal day. The control group consisted of 34 untreated animals. Both treated and untreated animals were sacrificed on the 24th, 42nd and 57th postnatal day, respectively, by decapitation. Following isolation and removal of soft tissue remnants jaws were radiographed using Siemens X-ray dental device. Morphometric measurements were performed with the following parametres: front and rear width and height of the maxillary arc, sagittal and vertical dimensions and coronal length of mandibular incisors. Values were statistically computed and elaborated by Student t-test. The significant level was 5% (p less than 0.05). The results showed that the mean values of the majority of parametres of both jaws were significantly lower in the group of treated animals compared to untreated group.

Animals↗
PubMed1986

The patterns on chondrogenesis of cells from facial primordia of chick embryos in micromass culture.

Chondrogenesis of mesenchymal cells from the frontonasal mass, mandibles and maxillae of stage-24 chick embryos has been investigated in micromass (high-density) cultures. Distinct differences in the amount and pattern of cartilage differentiation are found. In cultures of frontonasal mass cells, a central sheet of cartilage develops; in cultures of mandible cells, less cartilage differentiates and nodules form; while in cultures of maxillae cells, virtually no chondrogenesis takes place. The same patterns of cartilage are found in cultures established from stage-20 embryos. At stage 28, frontonasal mass cultures form cartilage nodules and the number of nodules in mandible cultures is markedly decreased. There are striking parallels between the chondrogenic patterns of cells from the face and limb buds in micromass culture. The frontonasal mass cell cultures of stage-20 and -24 chick embryos resemble those established from the progress zone of limb buds. The progress zone is an undifferentiated region of the limb in which positional cues operate. Cultures established from the frontonasal mass of stage-28 chick embryos and from the mandibles of all stages resemble cultures of whole limb buds. These contain a mixture of committed and uncommitted cells. Ectoderm from facial primordia locally inhibits chondrogenesis in micromass cultures and this could provide a positional cue. The differences in chondrogenic potential of cells from facial primordia may underlie the specific retinoid effects on the frontonasal mass.

Age Factors↗