Osteogenesis of Crouzon-Mutated Cells in an Experimental Model.

Crouzon syndrome is an autosomal-dominant congenital disease due to a mutation in the fibroblast growth factor receptor 2 protein. The purpose of this study is to evaluate wound-healing potential of Crouzon osteoblasts and adipose-derived stem cells (ADSCs) in a murine model. Parietal skull defects were created in Crouzon and mature wild-type (WT) CD-1 mice. One group of WT and Crouzon mice were left untreated. Another group was transplanted with both WT and Crouzon adipose-derived stem cells. Additional groups compared the use of a fibrin glue scaffold and periosteum removal. Skulls were harvested from each group and evaluated histologically at 8-week and/or 16-week periods. Mean areas of defect were quantified and compared via ANOVA F-test. The average area of defect after 8 and 16 weeks in untreated Crouzon mice was 15.37 ±â€Š1.08 cm and 16.69 ±â€Š1.51 cm, respectively. The average area of the defect in untreated WT mice after 8 and 16 weeks averaged 14.17 ±â€Š1.88 cm and 14.96 ±â€Š2.26 cm, respectively. WT mice with autologous ADSCs yielded an average area of 15.35 ±â€Š1.34 cm after 16 weeks while Crouzon mice with WT ADSCs healed to an average size of 12.98 ±â€Š1.89 cm. Crouzon ADSCs transplanted into WT mice yielded an average area of 15.47 ±â€Š1.29 cm while autologous Crouzon ADSCs yielded an area of 14.22 ±â€Š3.32 cm. ANOVA F-test yielded P = .415. The fibroblast growth factor receptor 2 mutation in Crouzon syndrome does not promote reossification of critical-sized defects in mature WT and Crouzon mice. Furthermore, Crouzon ADSCs do not possess osteogenic advantage over WT ADSCs.

Improved Temporomandibular Joint Position After 3-Dimensional Planned Mandibular Reconstruction.

PURPOSE: Virtual surgical planning (VSP) using computer-aided design and manufacturing (CAD-CAM) has been reported to aid in craniofacial reconstruction. The reported improvements have been related mainly to operative performance, with limited evaluations of the position and function of the temporomandibular joint (TMJ). This study analyzed the radiographic detail of postoperative outcomes related to the TMJ. MATERIALS AND METHODS: Patients who underwent mandibular reconstruction with and without VSP were analyzed. All patients underwent preoperative computed tomography (CT) of their mandible. In the VSP group, CAD-CAM planning was performed preoperatively using CT Digital Imaging and Communications in Medicine (DICOM) data. Postoperative CT images from the 2 groups were quantitatively compared to evaluate the TMJ. CT images were digitized for 2- and 3-dimensional analysis using surgical planning software (Materialise, Leuven, Belgium). Anatomic landmarks and cephalometric relations were analyzed. RESULTS: Sixteen patients who underwent traditional planning or VSP for mandibular reconstruction were compared. Two groups (n = 8 each) were compared for positioning of the mandibular condyle in the glenoid fossa. Measurements of superior, anterior, and lateral movements were comparable in the pre- and postoperative groups for the traditional and VSP groups (P < .001 by analysis of variance). Subgroup analysis evaluating ipsilateral changes in the mandibular condyle position for traditional planning versus VSP noted decreased percentages of change in superior (22 vs 10%; P < .05), anterior (32 vs 15%; P < .05), and lateral (7 vs 1%, P < .01) shifts of the condyle for left mandibular reconstructions (n = 8). Ipsilateral right mandibular reconstructions (n = 6) showed changes in superior (62 vs 15%; P < .05) and anterior (5 vs 9%; not significant) shifts. CONCLUSION: These data showed comparable pre- and postoperative positions of the TMJ for traditional and VSP mandibular reconstructions. Evaluation of condyle movements showed differences in the ipsilateral position in the pre- and postoperative groups. VSP resulted in decreased superior and lateral shifts of the ipsilateral condyle and decreased changes in the condylar and condylar neck angles. This work shows that VSP can lead to increased precision in reconstruction leading to preserved normative anatomic relations.

Three-dimensional virtual surgery accuracy for free fibula mandibular reconstruction: planned versus actual results.

PURPOSE: Virtual surgical planning (VSP) can promote efficiency, but the ability to transfer the proposed plan to the actual result has not been adequately studied. The purpose of this study was to morphometrically compare the virtually preplanned scenario with the postoperative 3-dimensional (3D) anatomic result. MATERIALS AND METHODS: A retrospective review of 10 patients who underwent mandibular reconstruction using a free fibula flap and VSP were evaluated. Pre- and postoperative Digital Imaging and Communications in Medicine files were imported into Mimics 10.01 software (Materialise, Leuven, Belgium) for surgical planning. Preoperative VSP and 1-week postoperative computed tomographic (CT) scans were evaluated to assess surgical accuracy using VSP. The pre- and postoperative morphometric measurements were compared using the Student t test. RESULTS: Twenty CT scans from 10 patients (mean age, 56.9±20.2 yr) who underwent partial mandibular resection were analyzed. The dimensions of the fibula segments after osteotomy showed no difference from the preoperative VSP (mean difference in fibula height, 1.2 mm; mean difference in width, 0.9 mm; mean difference in length, 1.3 mm). The postoperative anterior and posterior mandibular angles differed from the VSP by 12.4° and -12.5°, respectively. The condylar distance and inclination showed a discrepancy of only 1.7 mm and 4.6°, respectively, between VSP and postoperative CT scans. CONCLUSIONS: VSP confers reproducible precision and accuracy for free fibular mandibular reconstruction. The benefit was most striking for large reconstructions requiring multiple fibular segments. Future directions include assessing the use of external registration devices to enhance surgical accuracy and to follow patients longitudinally to monitor the long-term benefit of VSP.

Surgically assisted maxillary expansion imparts three-dimensional nasal change.

PURPOSE: The impact of surgically assisted maxillary expansion (SAME) on facial soft tissue structures has not been adequately studied using 3-dimensional (3D) objective analysis. The purpose of this study was to analyze nasolabial soft tissue after SAME using 3D photographic technology. MATERIALS AND METHODS: This was a retrospective cohort study of patients undergoing SAME in which pre- and postexpansion 3D photographs (3D VECTRA Photosystem, Canfield, Fairfield, NJ) were analyzed. Nasolabial anthropometric measurements were performed using the 3D postprocessing software (Mirror). A follow-up period of at least 6 months was required for final evaluation. Two observers verified the landmarks on each dataset before measuring. Statistical analysis involved the paired t test, the Simes correction for multiple comparisons, and repeated measures analysis of covariance (ANCOVA) to control for age, gender, and the time lag between pre- and postoperative assessments. RESULTS: Twelve patients (24 photogrammetric datasets) were included. The male-to-female ratio was 0.5 (mean age, 17.3 yr). Nasal changes after SAME showed significant increases (P < .05) in alar width (from 33.1 to 34.5 mm), sill width (from 9.2 to 9.7 mm), and columella projection (from 94.1 to 95.1 mm) after the Simes correction. ANCOVA showed a significant increase in alar base width. Distinct changes in nostril shape and dimension were found, but lacked statistical significance. CONCLUSION: Three-dimensional analysis shows widening of the alar width and alar base width after SAME. The magnitude of nasal change parallels that of expansion at the piriform aperture.

Simultaneous double-opposing Z-plasty and posterior pharyngeal flap.

PURPOSE: Strategies to address severe anteroposterior palatal shortening with velopharyngeal insufficiency include palatal lengthening or manipulation of posterior pharyngeal tissue as a flap or sphincter. In some cases, a single procedure alone is not sufficient to achieve dynamic velopharyngeal closure. The objective of this study was to determine whether double-opposing Z-plasty coupled with a posterior pharyngeal flap would achieve adequate palatal length in severe velopharyngeal dysfunction. MATERIALS AND METHODS: Six patients, 3 with previously unrepaired cleft palate and 3 children with previous straight-line repairs and significant anteroposterior shortening, were included. Demographic and perioperative information was tabulated. Subjective and objective speech data were gathered, if available. Complications, follow-ups, and postoperative nasometric results were compiled. Statistical analysis involved the paired t test. RESULTS: There were no perioperative complications. Follow-up was at least 1 year. No postoperative fistulas or nasal obstruction developed. Hypernasal speech and nasal emission were subjectively improved in all patients. Nasometric data showed a statistically significant improvement in nasal air escape with speech. CONCLUSIONS: Simultaneous double-opposing Z-plasty and posterior pharyngeal flap can be performed effectively. This strategy is useful for severe velopharyngeal dysfunction secondary to anteroposterior palatal shortening or a previously unrepaired cleft palate, and the technique optimizes palatal function and creates a mechanical blockade to nasal air escape.

Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters.

OBJECTIVE: To assess the diagnostic performance of quantitative and qualitative image parameters in cone-beam computed tomography (CBCT) for diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). MATERIALS AND METHODS: A BRONJ (22 patients, mean age 70.0 years) group was age and gender matched to a healthy control group (22 patients, mean age 68.0 years). On CBCT images two independent readers performed quantitative bone density value (BDV) measurements with region and volume-of-interest (ROI and VOI) based approaches and qualitative scoring of BRONJ-associated necrosis, sclerosis and periosteal thickening (1 = not present to 5 = definitely present). Intraoperative and clinical findings served as standard of reference. Interreader agreements and diagnostic performance were assessed by intraclass correlation coefficients (ICC), kappa-statistics and receiver-operating characteristic (ROC) analysis. RESULTS: Twenty-three regions in 22 patients were affected by BRONJ. ICC values for mean BDV VOI and mean BDV ROI were 0.864 and 0.968, respectively (p < 0.001). The area under the curve (AUC) for mean BDV VOI and mean BDV ROI was 0.58/0.83 with a sensitivity of 57/83% and specificity of 61/77% for diagnosis of BRONJ, respectively. Kappa values for presence of necrosis, sclerosis and periosteal thickening were 0.575, 0.617 and 0.885, respectively. AUC values for qualitative parameters ranged between 0.90-0.96 with sensitivity of 96% and specificities between 79-96% at respective cutoff scores. CONCLUSIONS: BRONJ can be effectively diagnosed with CBCT. Qualitative image parameters yield a higher diagnostic performance than quantitative parameters, and ROI-based attenuation measurements were more accurate than VOI-based measurements.

Outcome of comminuted mandibular fracture repair using an intraoral approach for osteosynthesis.

PURPOSE: Traditionally, the treatment of comminuted mandibular fractures involves both closed and open reduction. However, modern treatment principles increasingly tend toward open reduction and internal fixation to shorten oro-functional rehabilitation. Although this method increasingly gained popularity to date, a controversy regarding the extraoral versus the intraoral surgical approach still exists. The current study aimed to objectively evaluate the outcome of comminuted mandibular fracture treatment involving open reduction and internal fixation using an intraoral approach. PATIENTS AND METHODS: Consecutive patients treated at the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, between 2005 and 2012 were included. Demographic, presurgical, perisurgical, and postsurgical data were tabulated and statistically evaluated using the χ test and the Mann-Whitney U test. RESULTS: Forty-five patients could be included. Excellent postoperative results were seen in 84% (38 patients) of the total cohort. Postoperative complications were seen in 16% (7 patients). These 7 patients had the following complications: wound dehiscence (7% [n = 3]), osteomyelitis (7% [n = 3]), abscess development (4% [n = 2]), bone necrosis (2% [n = 1]), and severe nonocclusion (2% [n = 1]). CONCLUSION: Present data showed that the intraoral approach for open reduction and internal fixation in comminuted mandibular fractures represents a comparable surgical technique regarding fracture repositioning and occlusal rehabilitation. Considerably, the risk of concomitant neurovascular damage or even facial scarring, as demonstrated in the extraoral approach, can be neglected by using this technique. Nevertheless, each case has to be judged on its own accord as to which technique can best treat the underlying fracture.

Correction of severe enophthalmos by simultaneous fat grafting and anatomic orbital reconstruction.

BACKGROUND: Secondary enophthalmos correction, especially in severe cases, represents a surgical challenge. The complex injury pattern involving the hard and soft tissue warrants individualized multimodality treatment strategies. Even with seemingly successfully surgical execution, relapse or incomplete correction of globe position can occur. In an attempt to improve ability for correction, we have implemented concurrent endo-orbital fat grafting and orbital framework reconstruction. The purpose of this study is to describe our treatment approach and objectively analyze the results. METHODS: Preoperative and postoperative clinical examinations, Hertel measurements, and radiologic imaging were recorded. Orbitometric measurements were performed using a three-dimensional postprocessing software (SurgiCase; Materialise, Leuven, Belgium). A follow-up period of at least 6 months was taken for final evaluation. RESULTS: Postoperatively, all patients showed a significant improvement of the globe's position. Neither visual impairment nor disability of globe motility was seen. Hertel and three-dimensional orbitometric measurements showed significant (P < 0.05) globe projection improvement representing a mean of 4.2 and 3.7 mm. Orbital volume (25.65 mL) significantly decreased after surgery (22.98 mL). CONCLUSIONS: Alloplastic orbital floor reconstruction in combination with endo-orbital fat grafting represents an excellent method to achieve adequate globe support and positioning even in secondary enophthalmos correction.

Osteopathology induced by bisphosphonates and dental implants: clinical observations.

OBJECTIVES: Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy. PATIENT AND METHODS: In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review. RESULTS: Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease. CONCLUSIONS: Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor. CLINICAL RELEVANCE: The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.

Postoperative cranial vault growth in premature sagittal craniosynostosis.

Various techniques for the correction of sagittal craniosynostosis have been described in the literature. Nevertheless, there is a lack of consensus regarding surgical procedure and timing, although a long-term anthropometric analysis may shed light on this controversy. The aim of the current study was to collect serial anthropometric data of children before and after total cranial vault remodeling and to evaluate cranial vault growth pattern. Twenty-nine Swiss children with a surgical age between 8 and 10 months were included in this 5-year follow-up. Anthropologic data of sex- and age-matched healthy Swiss children served as a control. A standardized time protocol (before, after, 6 wk after surgery, 6 mo after surgery, and then annually until the age of six) for anthropometric skull measurements (head circumference, cranial length, breadth, and cephalic index) was used. Data were converted into the z score for standardized intercenter comparison. Postoperatively, all patients showed a marked benefit in cranial vault shape. Significant differences in long-term cranial growth pattern could be seen and a relapse into a dolichocephal skull growth. Both observations were rated as clinically irrelevant.

Cranial vault growth in multiple-suture nonsyndromic and syndromic craniosynostosis: a postoperative long-term anthropometric follow-up.

Long-term anthropometric follow-up of cranial vault growth may considerably add valuable information to current literature focusing on treatment strategies for premature multiple-suture craniosynostosis. The aim of this paper was to compare postoperative growth patterns of nonsyndromic and syndromic multiple-suture craniosynostotic children with sex-matched and age-matched children from the typically developing population. Forty-one multiple-suture craniosynostotic patients (19 nonsyndromic and 22 syndromic) were included in this 5-year follow-up. Anthropological data of sex-matched and age-matched normal Swiss children served as a control. A standardized time protocol for anthropometric skull measurements (head circumference and cephalic index) was used. Data were converted into Z-scores for standardized intercenter comparison. All patients showed a marked benefit in cranial vault shape after open skull remodeling. Significant differences in long-term cranial vault growth pattern could be seen between the nonsyndromic and the syndromic groups compared to the control group.

Peri-implant Parameters of Dental Implants Inserted in Prefabricated Microvascular Fibular Flaps: A Retrospective Study.

PURPOSE: To assess the peri-implant and flap parameters of the prefabricated microvascular fibula flap and determine the dental implant survival rate. MATERIALS AND METHODS: This retrospective study investigated a cohort of subjects who received prefabricated microvascular fibula flaps at two highly specialized tumor reconstruction centers. The subjects had all suffered atrophy or a large segmental defect of the jaws due to tumor resection or injury. Two independent surgeons determined the dental implant survival rate and assessed the peri-implant parameters and flap parameters during clinical follow-up. RESULTS: In total, 41 subjects were treated with a prefabricated fibula flap between 1999 and 2012. Of these, 17 subjects (10 male, 7 female) with a total of 62 dental implants were examined. The other 24 subjects were unavailable for assessment and had to be excluded. Ten of the 62 dental implants (16.1%) had to be removed due to peri-implantitis before the follow-up assessment. Follow-up assessments were performed at intervals ranging from 2 to 12 years (mean: 7.2 years) after fibula flap transplantation. The dental implant survival rate was found to be 83.9%. A total of 208 dental surfaces were assessed. Overall, 96% of all surfaces had a pocket depth (PD) of ≤ 4 mm and 4% had a pocket depth of > 5 mm. An attachment level (AL) of 3 mm was measured in 48.5% of implants and ≥ 5 mm was measured in 15.9% of implants. Dental implants with a PD > 4 mm showed a significantly higher plaque index (PI) (75%; P = .0057), papillary bleeding index (PBI) (62.5%; P = .0094), and radiologic bone loss (P = .0014) compared to dental implants with a PD ≤ 4 mm. CONCLUSIONS: Reconstructive surgery using microvascular fibula flaps represents an alternative tool for oral rehabilitation in subjects suffering from a large segmental defect in the maxillary or mandibular bone compared to the conventional method. However, it appears that the different ossification processes that develop the fibula and the jawbones affect dental implant survival.

Facial scars resulting from a transbuccal approach during osteosynthesis of a sagittal split osteotomy: A retrospective study.

The purpose of the current study was to assess the quality of facial linear scars. The Stony Brook Scar Evaluation Scale (SBSES) was developed and validated as a tool to assess postoperative scars. Postoperative facial scars were rated using high-quality macrophotographs and SBSES by three independent raters at baseline and three months thereafter. Percentage agreement (PA) and intraclass correlation coefficient (ICC) were used to measure interrater and intrarater reliability. Scar outcomes ranging from 0 (worst) to 5 (best) were evaluated against age and gender. One-hundred-sixty-six patients with a mean age of 30.6 years (range of 17-59) were included in this study. Forty-four were male (26.5%), and 122 were female (73.5%). Mean total SBSES scores were 4.63 (range of 4.56-4.76) at baseline and 4.60 (range of 4.54-4.72) at three months. As patient's age increased, mean total SBSES scores also decreased significantly (r = -0.216, p = 0.005). Gender did not significantly affect raters' perception of scar cosmesis (p = 0.847). Interrater reliability showed an ICC of 0.675 (95% CI, 0.609-0.731) and a PA of 65.4% at baseline, and an ICC of 0.655 (95% CI, 0.585-0.715) and a PA of 64.2% at three months. Intrarater reliability found ICCs ranging from 0.988 to 0.990 and a PA of 96.8% with 3 separate raters. Within the limitations of the study it seems that the transbuccal approach during osteosynthesis of a sagittal split osteotomy seems still to be acceptable when the patient gives his or her informed consent and advanced instruments like an angled screwdriver are not available.

Peri-implant Parameters of Dental Implants Inserted in Prefabricated Microvascular Fibular Flaps: A Retrospective Study.

PURPOSE: To assess the peri-implant and flap parameters of the prefabricated microvascular fibula flap and determine the dental implant survival rate. MATERIALS AND METHODS: This retrospective study investigated a cohort of subjects who received prefabricated microvascular fibula flaps at two highly specialized tumor reconstruction centers. The subjects had all suffered atrophy or a large segmental defect of the jaws due to tumor resection or injury. Two independent surgeons determined the dental implant survival rate and assessed the peri-implant parameters and flap parameters during clinical follow-up. RESULTS: In total, 41 subjects were treated with a prefabricated fibula flap between 1999 and 2012. Of these, 17 subjects (10 male, 7 female) with a total of 62 dental implants were examined. The other 24 subjects were unavailable for assessment and had to be excluded. Ten of the 62 dental implants (16.1%) had to be removed due to peri-implantitis before the follow-up assessment. Follow-up assessments were performed at intervals ranging from 2 to 12 years (mean: 7.2 years) after fibula flap transplantation. The dental implant survival rate was found to be 83.9%. A total of 208 dental surfaces were assessed. Overall, 96% of all surfaces had a pocket depth (PD) of ≤ 4 mm and 4% had a pocket depth of > 5 mm. An attachment level (AL) of 3 mm was measured in 48.5% of implants and ≥ 5 mm was measured in 15.9% of implants. Dental implants with a PD > 4 mm showed a significantly higher plaque index (PI) (75%; P = .0057), papillary bleeding index (PBI) (62.5%; P = .0094), and radiologic bone loss (P = .0014) compared to dental implants with a PD ≤ 4 mm. CONCLUSIONS: Reconstructive surgery using microvascular fibula flaps represents an alternative tool for oral rehabilitation in subjects suffering from a large segmental defect in the maxillary or mandibular bone compared to the conventional method. However, it appears that the different ossification processes that develop the fibula and the jawbones affect dental implant survival.

Segmental distraction osteogenesis of the anterior alveolar process using tooth-borne devices: is it skeletal movement or mainly dental tipping?

PURPOSE: Segmental distraction osteogenesis of the anterior alveolar process has been introduced as a technique designed to avoid extractions in patients with severe dental crowding. The aim of this study was to quantify the degree of dental tipping within the alveolar segment after distraction osteogenesis. PATIENTS AND METHODS: Patients treated for dental crowding, retruded anterior alveolar process, or flat curves of Spee using segmental distraction osteogenesis of the anterior alveolar process were included in the study. Dental-borne distraction devices were used while measuring points, and angles were defined to analyze the amount of dental tipping of the lower incisors after distraction. The measurements were performed using cone-beam computed tomographic scans. Periodontal health (eg, gingival recession, tooth mobility, and dental socket depths) was evaluated after distraction. A descriptive statistical analysis was performed. RESULTS: Fifteen patients were included in the study. The amount of dental tipping within the total movement of the alveolar process showed a mean of 24% after distraction osteogenesis, whereas the skeletal movement was 76%. Dental socket depths and tooth mobility remained at the same levels as those before distraction osteogenesis. In one third of patients, gingival recession was observed around the canines. CONCLUSIONS: Segmental distraction osteogenesis of the anterior process is a powerful technique that can prevent extractions in patients with dental crowding. The technique can also compensate for retruded anterior alveolar process and accelerate or decelerate the curve of Spee. Patients with constricted periodontal health and those with a thin mandibular symphysis, however, cannot be treated with this technique because of the increased risk of dental tipping. Severe gingival recession must also be considered a possible side effect associated with this technique.

Anterior alveolar segmental osteodistraction with a bone-borne device: clinical and radiographic evaluation.

PURPOSE: Anterior alveolar osteodistraction is a common method for enlargement of the dentoalveolar process, and bone-borne distraction devices are hypothesized to avoid the risk of dental tipping and periodontal impairment during distraction. The aim of this study was to objectify this thesis and to determine the reliability of bone-borne osteodistraction of the anterior alveolar process. PATIENTS AND METHODS: The study group consisted of 18 consecutive patients who underwent anterior alveolar segmental distraction with a bone-borne distraction device for the treatment of dental crowding or alveolar retrusion from 2008 through 2011. Clinical and radiologic changes within the apical base and dentoalveolar process were analyzed after bone-borne distraction osteogenesis. All measurements were carried out using cone-beam computed tomography. RESULTS: Surgery and the postoperative period were uneventful in all patients. Mean alveolar movement was 8.2° ± 2.4°. Skeletal movement was 97.6% and absolute dental tipping was 2.4%. A mean change in the occlusal plane of 1.9° ± 1.1° was verified. The apical base enlargement showed a mean of 7.9 ± 1.4 mm, and the dentoalveolar arch a mean increase of 12.7 ± 2.1 mm. Within the distraction zone, a mean vertical bone loss of 3.5 ± 0.7 mm and a mean horizontal bone loss of 3.9 ± 0.8 mm were seen. After orthodontic gap closure, both were clinically irrelevant, with no need for additional bone grafts. Periodontal impairment (gingival recessions of 1 mm) was observed in 7 patients but affected only the teeth bordering the vertical osteotomy line. CONCLUSIONS: Bone-borne anterior alveolar osteodistraction is sufficient for enlargement of the apical base and the dentoalveolar arch of the mandible. Skeletal movement of the alveolar segment was predictable and dental tipping was clinically irrelevant. This technique presents further indications and approaches in orthognathic surgery.

Hybrid distraction: a novel method for distraction osteogenesis of the alveolar process.

Segmental distraction osteogenesis of the anterior alveolar process is a sufficient method to enlarge the alveolar arch. Indications for this method are dental crowding, retroalveolism, and leveling of the curve of Spee. However, after the distraction period, the anterior alveolar segment often shows an unfavorable inclination resulting in nonphysiologic load on the lower incisors.The aim of this paper was to introduce a new approach in segmental distraction osteogenesis of the anterior alveolar process. This new method combines 2 different surgical techniques: a segmental osteotomy for the alveolar ridge with instant fixation in the desired position and a distraction procedure for the alveolar segment. This hybrid distraction avoids an unfavorable inclination of the lower incisors after front-block distraction procedures.

Growing skull fractures after craniosynostosis repair: risk factors and treatment algorithm.

Growing skull fractures (GSFs) are rare complications after severe head injuries in the early childhood and rarely occur after craniosynostosis repair. The aim of this study was to define an algorithm for sufficient treatment for GSF after craniofacial procedures. Literature research was performed to clarify risk factors for GSFs after cranial vault reshaping. Conclusions of the literature and experiences of the authors based on a case of GSF after craniofacial surgery were matched to establish guidelines for successful therapy.

Craniofacial landmarks in young children: how reliable are measurements based on 3-dimensional imaging?

INTRODUCTION: Different approaches for 3-dimensional (3D) data acquisition of the facial surface are common nowadays. Meticulous evaluation has proven their level of precision and accuracy. However, the question remains as to which level of craniofacial landmarks, especially in young children, are reliable if identified in 3D images. Potential sources of error, aside from the systems technology itself, need to be identified and addressed. Reliable and unreliable landmarks have to be identified. MATERIALS AND METHODS: The 3dMDface System was used in a clinical setting to evaluate the intraobserver repeatability of 27 craniofacial landmarks in 7 young children between 6 and 18 months of age with a total of 1134 measurements. RESULTS: The handling of the system was mostly unproblematic. The mean 3D repeatability error was 0.82 mm, with a range of 0.26 mm to 2.40 mm, depending on the landmark. Single landmarks that have been shown to be relatively imprecise in 3D analysis could still provide highly accurate data if only 1 of the 3 spatial planes was relevant. There were no statistical differences from 1 patient to another. CONCLUSIONS: Reliability in craniofacial measurements can be achieved by such 3D soft-tissue imaging techniques as the 3dMDface System, but one must always be aware that the degree of precision is strictly dependent on the landmark and axis in question.For further clinical investigations, the degree of reliability for each landmark evaluated must be addressed and taken into account.

[Local anesthetics with elderly patients]. / Die Anwendung von Lokalanästhetika bei Patientinnen und Patienten im Alter.

When choosing local anesthetics, risk factors such as underlying diseases, use of other medications and allergies have to be taken into consideration. Systematic complications might occur if a specific limit in the plasma concentration is exceeded. Articaine and prilocaine are metabolized extrahepatically. In case of an absolute contraindication for vasoconstrictors, the use of mepivacaine, bupivacaine or articaine is recommended.