[Patient follow-up after orthognathic surgery. Interview by Michel Richter].
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Adult↗
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Results for “Maxillofacial Abnormalities”
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Three-dimensional technology for documentation and record keeping for patients with facial clefts.
The surface laser scanner has great potential as a method for documentation of cleft infant due to its accuracy, ease of use, and convenience. The image scan be stored in the computer for easy access. As purchasing costs decrease, its acquisition will be facilitated, resulting in an increase in its use.
Cleft Lip↗
Long-term results of distraction osteogenesis of the maxilla and midface.
Since the beginning of 1998, eight patients have been treated by osteodistraction to correct hypoplasia of the maxilla and midface of various origins. Among them were five patients who were treated by high LeFort I osteotomies and insertion of subcutaneous intraoral distraction devices in the malar region. In the remaining three patients, extraoral distraction devices were applied after LeFort II and III osteotomies. Distraction osteogenesis was successful in all cases, resulting in a mean sagittal bone gain measured parallel to the skull base of 9.0 mm (range 4.5-12.0) in the group treated with intraoral distractors and a mean of 20.3 mm in the extraoral distraction group (range 15.0-25.0). All patients were kept under orthodontic supervision before, during, and after osteodistraction. Long-term cephalometric and clinical evaluation after a mean follow-up period of 24 months in the intraoral distraction group (range 22-26) and 12 months in the extraoral distraction group (range 10-14) show stable results concerning the skeletal and dental relations. Long-term follow-up is necessary.
Adolescent↗
Concomitant temporomandibular joint and orthognathic surgery.
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Bone Resorption↗
A case of maxillary and zygomatic duplication.
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Child↗
Morphologic and biomechanical determinants in the selection of orthognathic surgery procedures.
PURPOSE: This study examined which features of craniofacial morphology are most important in the selection of an orthognathic surgery procedure by 1) producing a small number of composite variables representing multiple measures of craniofacial morphology and craniofacial biomechanics, and 2) looking for correlations between these composite variables and selected orthognathic surgery procedures. PATIENTS AND METHODS: Lateral cephalograms of 201 adult subjects (71 men and 130 women) were used to generate 47 standard cephalometric measures and 30 biomechanical measures. Of the 201 subjects, 121 were scheduled for orthognathic surgery to treat a variety of dentofacial deformities. Factor analysis reduced the number of variables by identifying underlying latent composite variables, thereby strengthening correlations among the reduced number. Weightings for each factor were than compared among the orthognathic surgery procedures, indicating which factors may have influenced the selection of that procedure. RESULTS: Factor analysis determined 12 factors (explaining 93% of the variance) for the morphologic measurements and 6 factors (explaining 90% of the variance) for the biomechanical measurements. However, only 6 of the morphology factors (accounting for 53% of the morphologic variance) and 5 of the biomechanics factors (accounting for 69% of the biomechanics variance) significantly separated any of the 10 treatment groups. The separating morphology factors were generally related to relative maxillary and mandibular position or dental relationships. Of these, relative maxilla/mandible anteroposterior position was most important for defining the surgery groups. The biomechanics of the lateral pterygoid muscles did not contribute to separation of the groups. CONCLUSIONS: Only a subset of available morphologic information was used to select surgical treatment. The most important factors in treatment selection were difference in maxillary and mandibular lengths and differences in anterior and posterior facial height. Standard morphology factors accounting for 40% of the total morphologic variance apparently played no role in selection of treatment. Several biomechanical factors differentiated treatment groups as well as or better than some standard morphology factors.
Adult↗
Cephalometric characteristics of anterior open bite in a southern Chinese population.
The cephalometric characteristics of skeletal anterior open bite (AOB) in a southern Chinese population were evaluated in a group of 104 subjects with AOB and were compared with a control group of 40 subjects without AOB. The anteroposterior jaw relationship in the AOB group was Class I in 43%, Class II in 14%, and Class III in 43%. Cephalometric analysis of all subjects was completed by using 24 skeletal and 12 dentoalveolar measurements. Sexually dimorphic variables were identified and compared separately between groups with independent t tests. Two levels of significance were used, P < or = 0.05 and P < or = 0.001. Sexual dimorphism of cephalometric variables was present in both the test and the control groups, but affected more variables in the test group. Significant findings in AOB were shorter anterior cranial base, upward and forward rotation of the maxilla, increased gonial and mandibular plane angles, increased upper posterior dental height, and increased lower anterior facial height. These findings generally coincided with those for white subjects, however, there was no conclusive evidence in this study regarding the contribution of the upper anterior facial height or the posterior facial height to the AOB deformity.
Adolescent↗
Assessment of patients for orthognathic surgery.
Rapid advances in orthognathic surgery now allow the clinician to treat severe dentofacial deformities that were once only manageable by orthodontic camouflage. These cases were often compromised with unacceptable facial esthetics and unstable occlusal results. Over the past 25 years, there have been numerous improvements in technology and the surgical management of dentofacial deformities. These progressions now allow more predictable surgical outcomes, which ensure patient satisfaction. Not all patients are candidates for surgical treatment; therefore, patient assessment and selection remains paramount in the process of diagnosing and treatment planning for this type of irreversible treatment. The inclusion of patients in the decision-making process increases their awareness and acceptance of the final result. The past three decades indicate an increased usage of orthodontic treatment by both children and adults. Patient demographic profiles for severe occlusal and facial characteristics are presented in an effort to understand the epidemiological factors of malocclusion and predict the population's need for this service.
Adult↗
Patient specific finite element model of the face soft tissues for computer-assisted maxillofacial surgery.
This paper addresses the prediction of face soft tissue deformations resulting from bone repositioning in maxillofacial surgery. A generic 3D Finite Element model of the face soft tissues was developed. Face muscles are defined in the mesh as embedded structures, with different mechanical properties (transverse isotropy, stiffness depending on muscle contraction). Simulations of face deformations under muscle actions can thus be performed. In the context of maxillofacial surgery, this generic soft-tissue model is automatically conformed to patient morphology by elastic registration, using skin and skull surfaces segmented from a CT scan. Some elements of the patient mesh could be geometrically distorted during the registration, which disables Finite Element analysis. Irregular elements are thus detected and automatically regularized. This semi-automatic patient model generation is robust, fast and easy to use. Therefore it seems compatible with clinical use. Six patient models were successfully built, and simulations of soft tissue deformations resulting from bone displacements performed on two patient models. Both the adequation of the models to the patient morphologies and the simulations of post-operative aspects were qualitatively validated by five surgeons. Their conclusions are that the models fit the morphologies of the patients, and that the predicted soft tissue modifications are coherent with what they would expect.
Biomechanical Phenomena↗
Development of a condition-specific quality of life measure for patients with dentofacial deformity: I. Reliability of the instrument.
UNLABELLED: The assessment of quality of life is becoming increasingly important in clinical research. Its importance in dentistry has been realised only relatively recently. Health-related quality of life is concerned with the aspects of quality of life that relate specifically to an individual's health. This may be measured using two groups of instruments: (i) generic measures, which provide a summary of health-related quality of life and sometimes generate a single index measure of health or (ii) condition-specific measures, which focus on a particular condition, disease, population or problem and are potentially more responsive to small, but clinically important, changes in health. OBJECTIVES: The aim of this study was to develop a condition-specific quality of life measure for those patients with severe dentofacial deformity who were requesting orthognathic treatment and to assess the reliability of this instrument. METHOD: Instrument content was derived through a literature review and interviews with clinicians and patients. The resulting instrument was tested for internal consistency and test-retest reliability. RESULTS AND CONCLUSION: The instrument was found to divide into four clinically meaningful domains. Internal consistency and test-retest reliability were good. Patient acceptance of the questionnaire was also encouraging.
Health Services Needs and Demand↗
Family impact of child oral and oro-facial conditions.
OBJECTIVES: The aim of this study was to develop and evaluate the Family Impact Scale, a measure of the family impact of child oral and oro-facial disorders. This formed one component of the Child Oral Health Quality of Life Instrument. METHODS: The scale was developed using a process described by Guyatt et al. (1987) and Juniper et al. (1996). An item pool was developed using a review of existing child health status and family impact questionnaires, interviews with 41 parents-caregivers of children with paedodontic, orthodontic and oro-facial conditions and discussions with dental specialists. The resulting pool of 21 items was used in an item impact study in which 93 parents-caregivers provided data on the frequency and importance of these items. The 14 items identified most frequently or rated the most important were selected for the final questionnaire. The discriminant and construct validity and internal consistency reliability of this 14-item scale were assessed in a study of 266 parents-caregivers from the three clinical groups. Seventy-nine of these participants completed a second copy of the questionnaire to facilitate assessment of test-retest reliability. RESULTS: Family Impact Scale scores ranged from 0 to 33, indicating that the measure was sensitive to variations in family impact. Floor effects were minimal with only 10.2% of subjects having a score of zero and there were no ceiling effects, that is, subjects with maximum scores. Almost three-quarters of parents-caregivers reported some family impact 'sometimes' or 'often/everyday' over the previous 3 months. Impact on parental or family activities of this frequency was reported by 53.0%, impact on parental emotions by 44.0%, conflict in the family by 31.6% and financial difficulties by 31.2%. The measure and its component items were reasonably good at discriminating between the three clinical groups included in the study and showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.83 and was reproducible for parent-caregivers who reported that their child's condition was stable (ICC = 0.80). CONCLUSIONS: The study provides some data to suggest that child oral and oro-facial conditions have a pervasive impact on the family. The Family Impact Scale had good technical properties. Its evaluative properties need to be tested in longitudinal studies.
Adolescent↗
Development of a condition-specific quality of life measure for patients with dentofacial deformity: II. Validity and responsiveness testing.
UNLABELLED: The assessment of quality of life is becoming increasingly important in dentistry. This may be measured using two groups of instruments: generic and condition-specific. OBJECTIVES: This paper describes the processes of validity and responsiveness testing of a condition-specific quality of life measure for patients who present with severe dentofacial deformity requesting orthognathic treatment (the so-called Orthognathic Quality of Life Questionnaire). The development of the instrument is described in a previous paper. METHOD: The OQLQ was tested for validity using a visual analogue scale and also the Short-Form 36 health survey questionnaire. Responsiveness was tested using longitudinal data obtained before, during and after orthognathic treatment. RESULTS AND CONCLUSIONS: The OQLQ shows good evidence of validity and responsiveness. This, together with previous evidence of good reliability, suggests that the instrument may prove useful in both clinical trials and in quality assurance.
Adult↗
Collagen XI sequence variations in nonsyndromic cleft palate, Robin sequence and micrognathia.
Cleft palate is a common birth defect, but its etiopathogenesis is mostly unknown. Several studies have shown that cleft palate has a strong genetic component. Robin sequence consists of three of the following four findings: micrognathia, glossoptosis, obstructive apnea, and cleft palate. While cleft palate is mainly nonsyndromic, about 80 percent of Robin sequence cases are associated with syndromes. Mutations in genes coding for cartilage collagens II and XI, COL2A1, COL11A1 and COL11A2, have been shown to cause chondrodysplasias that are commonly associated with Robin sequence, micrognathia or cleft palate. We therefore analyzed a cohort of 24 patients with nonsyndromic Robin sequence, 17 with nonsyndromic cleft palate and 21 with nonsyndromic micrognathia for mutations in COL11A2. A total of 23 Robin sequence patients were also analyzed for mutations in COL2A1 and COL11A1. We detected two disease-associated mutations in patients with Robin sequence, an Arg to stop codon mutation in COL11A2 and a splicing mutation in COL11A1. Two putatively disease-associated sequence variations were found in COL11A1 in Robin sequence patients, one in COL11A2 in a patient with micrognathia and one in COL2A1 in two patients with Robin sequence. The results showed that sequence variations in these genes can play a role in the etiology of Robin sequence, cleft palate and micrognathia but are not common causes of these phenotypes.
Cleft Palate↗
Severe hyponatraemia after plastic surgery in a girl with cleft palate, medial facial hypoplasia and growth retardation.
A ten-year-old girl with middle face hypoplasia, cleft lip and palate developed severe hyponatraemia on the first day following surgery. Final diagnosis was inappropriate secretion of antidiuretic hormone (ADH) and complete hormonal investigation revealed partial deficit in growth hormone secretion. The incidence of hormonal deficiency associated to midline facial malformations is discussed.
Child↗
Changes in temporomandibular joint dysfunction after orthognathic surgery.
PURPOSE: We sought to evaluate the effects of orthognathic surgery on temporomandibular joint (TMJ) dysfunction in patients with known presurgical TMJ internal derangement who underwent double-jaw surgery for the treatment of dentofacial deformities. PATIENTS AND METHODS: Treatment records of 25 patients with magnetic resonance imaging and clinical verification of preoperative TMJ articular disc displacement who underwent double-jaw surgery only were retrospectively evaluated, with an average follow-up of 2.2 years. Signs and symptoms of TMJ dysfunction, including pain, range of mandibular motion, and presence/absence of TMJ sounds, were subjectively (visual analog scales) and objectively evaluated at presurgery (T1), immediately postsurgery (T2), and at longest follow-up (T3). Surgical change (T2-T1) and long-term stability of results (T3-T2) were calculated using the superimposition of lateral cephalometric and tomographic tracings. RESULTS: Presurgery, 16% of the patients had only TMJ pain, 64% had only TMJ sounds, and 20% had both TMJ pain and sounds. Postsurgery, 24% of the patients had only TMJ pain, 16% had only TMJ sounds, and 60% has both TMJ pain and sounds. Thus, presurgery 36% of the patients had TMJ pain, and postsurgery, 84% had pain. Average visual analog scale pain scores were significantly higher postsurgery and none of the patients with presurgery TMJ pain had relief of pain postsurgery. In addition, 6 patients (24%) developed condylar resorption postsurgically, resulting in the development of Class II open bite malocclusion. CONCLUSIONS: Patients with preexisting TMJ dysfunction undergoing orthognathic surgery, particularly mandibular advancement, are likely to have significant worsening of the TMJ dysfunction postsurgery. TMJ dysfunction must be closely evaluated, treated if necessary, and monitored in the orthognathic surgery patient.
Adolescent↗
Axial pattern flap based on the cutaneous branch of the superficial temporal artery in dogs: an experimental study and case report.
OBJECTIVE: To determine the anatomic guidelines and viability of an axial pattern flap based on the cutaneous branch of the superficial temporal artery (STA) in dogs. Application of the flap in a clinical patient is reported. STUDY DESIGN: Flap viability in control and experimental groups was determined 7 days postoperatively. ANIMALS: A total of 14 mature, mesaticephalic dogs; 1 clinical patient. METHODS: The cutaneous branch of the STA and vein were incorporated in the flaps of the experimental groups (group A, n = 5; group B, n = 4) and were ligated in the control group (n = 5). Flap length was extended in experimental group B. Seven days postoperatively, the length and area of tissue that remained viable in each flap was determined and compared with similar measurements performed intraoperatively. Cutaneous fluorescence was also used postoperatively to assess flap perfusion. The flap used in the clinical patient had the same dimensions as flaps developed in group A. RESULTS: Mean survival length (+/- SD) of STA flaps [group A, 9.1 (0.8) cm], was significantly increased (P < .05) compared with control flaps [7.0 (0.6) cm]. Percentage flap length survival (+/- SD) of STA flaps [group A, 91.8 (8.9)%], was significantly increased (P < .05) compared with control flaps [71.6 (7.0)%]. Mean percentage area of survival (+/- SD) of STA flaps [group A, 93.1 (7.5)%], was significantly increased (P < .05) compared with control flaps [73.5 (7.4)%]. Group B flaps had a mean survival length of 10.4 (1.1) cm, percentage flap length survival of 69.5 (4.8)%, and mean percentage area of survival of 69.1 (6.5)%. There was no positive correlation between the area of flap fluorescence at days 0, 1, and 3, and the area of flap survival. Application of the flap in a clinical patient allowed primary wound reconstruction with 100% survival. CONCLUSION: A flap based on the cutaneous branch of the STA may be a source of skin for reconstructive procedures of the maxillofacial region in dogs. CLINICAL RELEVANCE: Knowledge of the anatomic landmarks and expected viability of a STA axial pattern flap is essential before consideration of its use as a reconstructive surgical technique.
Animals↗
Digital imaging in the assessment of facial deformity.
A combination of digital imaging and conventional radiographic techniques has been used to obtain a life-size composite image of the facial soft tissue profile, the skull, and the teeth, anatomically superimposed on each other. The system overcomes major problems associated with assessment of facial deformity such as magnification, the exposure of photographs and radiographs from different positions, radiographs with overexposed soft tissue profiles, lengthy procedures in photographic studios, and, in addition, enables a degree of partial automation in the management of patients.
Analog-Digital Conversion↗
Endoscopic treatment of sinonasal disease in patients who have had orthognathic surgery.
Certain skeletofacial patterns may be predisposed to aggravated sinonasal disease postoperatively. These may include, but are not limited to, facial skeletal asymmetries with high septal deviations and those with obstructive nasal respiration and mouth breathing that leads to skeletal growth disturbances such as vertical maxillary hyperplasia and apertognathism. These sinonasal diseases may partly be the result of osteomeatal blockage by pre-existing structures, or synechial shelves and webs blocking normal maxillary antral mucosal flow. The use of nasal antral windows placed anteriorly in the lateral nasal wall at the time of downfracture LeFort (Hosaka window) do not seem to benefit the drainage of the maxillary antrum. This is because physiological flow often bypasses this region. If patients present postoperatively with new sinonasal disease or the aggravation of pre-existing symptoms, evaluation by both endoscopically assisted intranasal and axially and coronal computed tomography (CT) is recommended. Functional endoscopic sinus surgery by the minimally invasive Messerklinger technique, combined with intranasal use of laser-assisted turbinoplasty and soft tissue lysis, have been successfully used for most of these patients. Because the anatomical positioning of the midfacial structure can potentially affect patients with a predisposition to sinonasal physiological disturbances, consideration should be given to preoperative evaluation and discussion of potential consequences.
Adult↗