Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
1.
Int J Oral Maxillofac Surg ; 50(6): 763-773, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33218918

RESUMEN

The aim of this study was to compare the outcomes of surgical-orthodontic treatment between hemifacial microsomia (HFM) patients who had and had not undergone early mandibular distraction osteogenesis (DO). Twenty adult unilateral HFM patients were included, seven who had undergone early mandibular DO (DO group) and 13 who had not (NDO group). All patients were type IIB, except for one type IIA patient in the NDO group. Mean age at definitive surgery was 20.72±2.96 years. Linear, cross-sectional, and volumetric measurements were obtained from serial cone beam computed tomography scans. Data were obtained pre-surgery (T0), 1 week after surgery (T1), and at treatment completion (T2) to determine surgical movement, post-surgical stability, and net gain movement. Surgical and ultimate outcomes did not differ significantly between the groups. The overall surgical movement among all patients was as follows (mean values): maxillomandibular complex (MMC) symmetry was achieved by Le Fort I differential roll movement (3.78mm extrusion on the affected side, 4.28mm impaction on the non-affected side), a combination of medial movement and yaw rotation of MMC, and genioplasty. Upper and lower dental midlines and deviated menton were shifted by 5.73mm, 5.08mm, and 12.38mm, respectively. Anterior impaction and advancement with counterclockwise rotation of MMC were also performed. Menton was advanced by 6.14mm and lower facial height was increased by 3.55mm. Neither group exhibited a significant difference in stability. Relapse at the maxilla was <1mm and relapse at the mandible was <1.5mm. The results suggest that early DO had limited beneficial effects on the definitive correction outcome. HFM patients achieved acceptable symmetry and a stable surgical outcome, regardless of early DO, following surgical-orthodontic correction at skeletal maturity with three-dimensional surgical simulation.


Asunto(s)
Síndrome de Goldenhar , Osteogénesis por Distracción , Adulto , Estudios Transversales , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/cirugía , Síndrome de Goldenhar/diagnóstico por imagen , Síndrome de Goldenhar/cirugía , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Resultado del Tratamiento
2.
Int J Oral Maxillofac Surg ; 46(7): 811-818, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28359687

RESUMEN

This study was conducted to analyze the long-term facial growth of patients with craniofacial microsomia (CFM) after early mandible distraction osteogenesis (DO), and compared adult three-dimensional (3D) craniofacial features of patients with and without early mandibular DO for Pruzansky grade II deformities. The study included 20 patients: 9 with early mandible DO (the DO group) and 11 without previous treatment (the NDO group). Longitudinal radiographs were measured for growth changes after DO. The 3D craniofacial images were constructed to compare the craniofacial forms between the two groups. The patients with early DO presented 8 to 9mm forward and downward maxillary growth and 4.6mm limited forward and 17.3mm substantial downward mandibular growth. The ramus length ratio (affected/nonaffected) was 90.8% at DO completion and decreased to 69.5% at growth completion during 13 years of follow-up. Both groups showed obvious craniofacial asymmetry, as indicated by occlusal plane canting, chin deviation, transverse and vertical condyle positions, and mandibular contours. Although all the bilateral differences were higher in the NDO group than in the DO group, no statistical differences were found. Early mandible distraction could not alter the inherent facial growth pattern in patients with grade II CFM. Limited changes are derived for definitive facial correction with early DO.


Asunto(s)
Síndrome de Goldenhar/cirugía , Mandíbula/cirugía , Desarrollo Maxilofacial , Osteogénesis por Distracción/métodos , Adulto , Tomografía Computarizada de Haz Cónico , Femenino , Síndrome de Goldenhar/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Masculino , Mandíbula/anomalías , Radiografía Panorámica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
3.
Clin Genet ; 88(3): 255-60, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25142838

RESUMEN

Kabuki or Niikawa-Kuroki syndrome (KS) is a rare disorder with multiple malformations and recurrent infections, especially otitis media. This study aimed to investigate the genetic defects in Kabuki syndrome and determine if immune status is related to recurrent otitis media. Fourteen patients from 12 unrelated families were enrolled in the 9-year study period (2005-2013). All had Kabuki faces, cleft palate, developmental delay, mental retardation, and the short fifth finger. Recurrent otitis media (12/14) and hearing impairment (8/14) were also more common features. Immunologic analysis revealed lower memory CD19+ cells (11/13), lower memory CD4+ cells (8/13), undetectable anti-HBs antibodies (7/13), and antibody deficiency (7/13), including lower IgA (4), IgG (2), and IgG2 (1). Naïve emigrant lymphocytes, lymphocyte proliferation function, complement activity, and superoxide production in polymorphonuclear cells were all normal. All the patients had KMT2D mutations and 10 novel mutations of R1252X, R1757X,Y1998C, P2550R fs2604X, Q4013X, G5379X, E5425K, R5432X, R5432W, and R5500W. Resembling the phenotype of common variable immunodeficiency, KS patients with antibody deficiency, decreased memory cells, and poor vaccine response increased susceptibility to recurrent otitis media. Large-scale prospective studies are warranted to determine if regular immunoglobulin supplementation decreases the frequency of otitis media and severity of hearing impairment.


Asunto(s)
Anomalías Múltiples/genética , Anomalías Múltiples/inmunología , Proteínas de Unión al ADN/genética , Cara/anomalías , Enfermedades Hematológicas/genética , Enfermedades Hematológicas/inmunología , Mutación , Proteínas de Neoplasias/genética , Enfermedades Vestibulares/genética , Enfermedades Vestibulares/inmunología , Anomalías Múltiples/diagnóstico , Análisis Mutacional de ADN , Disgammaglobulinemia/genética , Disgammaglobulinemia/inmunología , Femenino , Enfermedades Hematológicas/diagnóstico , Humanos , Recuento de Linfocitos , Masculino , Fenotipo , Enfermedades Vestibulares/diagnóstico
4.
Int J Oral Maxillofac Surg ; 40(7): 672-8, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21458233

RESUMEN

Median facial dysplasia affects a subset of patients with cleft lip and palate exhibiting certain characteristics of median facial structure deficiencies without definable gross abnormalities of the brain. The aim of this study was to describe the craniofacial and dental morphology of almost skeletally mature patients with median facial dysplasia. Patients were selected for this retrospective study if they were diagnosed with median facial dysplasia and ≥15 years old. The craniofacial and dental morphology was evaluated by analysing cephalometric and panoramic radiographs. This sample of median facial dysplasia patients (9 males and 11 females; 6 unilateral and 14 bilateral clefts) had a mean age of 16.7 ± 1.9 years. Controls were age-, sex-, cleft type-matched, and nonsyndromic patients. The results showed that in patients with median facial dysplasia, the anterior cranial base and midface were shorter than in controls. The median facial dysplasia inter-orbital distance was shorter and the nasal bone was more retrusive than in controls. All patients with median facial dysplasia had several missing permanent teeth. These features require extensive surgical, orthodontic, and dental rehabilitation procedures.


Asunto(s)
Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Huesos Faciales/anomalías , Anomalías Dentarias/patología , Adolescente , Puntos Anatómicos de Referencia/patología , Anodoncia/patología , Estudios de Casos y Controles , Cefalometría/métodos , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incisivo/anomalías , Estudios Longitudinales , Masculino , Mandíbula/patología , Maxilar/patología , Hueso Nasal/anomalías , Hueso Nasal/patología , Órbita/anomalías , Órbita/patología , Radiografía Panorámica , Estudios Retrospectivos , Base del Cráneo/anomalías , Base del Cráneo/patología , Erupción Ectópica de Dientes/patología , Diente Impactado/patología , Adulto Joven
5.
Plast Reconstr Surg ; 108(7): 1862-70, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11743369

RESUMEN

This article describes how the Craniofacial Imaging Laboratory at the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University Medical Center, has developed an electronic archive for the storage of computed tomography image digital data that is independent of scanner hardware and independent of units of storage media (i.e., floppy disks and optical disks). The archive represents one of the largest repositories of high-quality computed tomography data of children with craniofacial deformities in the world. Archiving reconstructed image data is essential for comparative imaging, surgical simulation, quantitative analysis, and use with solid model fabrication (e.g., stereolithography). One tertiary craniofacial center's experience in the establishment and maintenance of such an archive through three generations of storage technology is reported. The current archive is housed on an external 35-GB hard drive attached to a Windows-based desktop server. Data in the archive were categorized by specific demographics into groups of patients, number of scans, and diagnoses. The Craniofacial Imaging Laboratory archive currently contains computed tomography image digital data for 1827 individual scans. The earliest scan was done in 1980; the most recently stored scan for the purposes of this report occurred in May of 2000. The average number of scans archived per complete year was 94, with a range of 59 to 138. Of the 1827 total scans, 74 percent could be classified into specific diagnostic categories. The majority of the archive (55 percent) is composed of the following five diagnoses: sagittal synostosis (17 percent), unilateral coronal synostosis (11 percent), hemifacial microsomia (10 percent), plagiocephaly without synostosis (10 percent), and metopic synostosis (7 percent). Storage of computed tomography image data in a digital archive currently allows for continuous upgrading of image display and analysis and facilitates longitudinal and cross-sectional studies, both intramural and extramural. Internet access for clinical and research purposes is feasible, but contingent on protection of patient confidentiality. The future of digital imaging regarding craniofacial computed tomography scan storage and processing is also discussed.


Asunto(s)
Anomalías Craneofaciales/diagnóstico por imagen , Imagenología Tridimensional , Sistemas de Información Radiológica , Tomografía Computarizada por Rayos X , Niño , Craneosinostosis/diagnóstico por imagen , Asimetría Facial/diagnóstico por imagen , Hospitales Pediátricos , Humanos , Imagenología Tridimensional/estadística & datos numéricos , Sistemas de Información Radiológica/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
6.
Chang Gung Med J ; 24(4): 229-38, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11413880

RESUMEN

BACKGROUND: Adequate assessment of the deformity, formulation of good treatment planning, and sufficient rehearsal of procedures before actually performing surgery ensure successful craniofacial surgery. Three-dimensional computed tomography (CT) imaging and facsimile models were used in combination to evaluate their function in craniofacial surgery. METHODS: Three-dimensional imaging and facsimile models were used for reconstruction of craniofacial deformity. CT data were acquired, processed, and reconstructed to display 3-dimensional images. The images were used for evaluation of the deformity. The images were then manipulated to create multiple osseous objects. Surgical simulation was performed by moving the computer images. The image processing and manipulation were achieved using the AnalyzePC program. The raw CT data were transformed into a readable format and transferred to produce facsimile models using rapid prototyping technology. The skull models were used for evaluation and surgical simulation. Both methods were compared and used to assist in surgery, which was performed according to the simulations. RESULTS: Three-dimensional CT imaging and facsimile models were helpful for simulation of craniofacial surgery. The actual surgery results were satisfactory without complications. Particular advantages were the unlimited trials with the imaging method, and the feeling of reality with the model method. CONCLUSIONS: Craniofacial surgery is facilitated by preoperative simulation of procedures. Both 3-dimensional CT imaging and facsimile models are helpful for craniofacial surgical simulation.


Asunto(s)
Huesos Faciales/cirugía , Modelos Anatómicos , Cráneo/cirugía , Anomalías Craneofaciales/cirugía , Humanos , Tomógrafos Computarizados por Rayos X
7.
Cleft Palate Craniofac J ; 37(5): 506-11, 2000 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11034035

RESUMEN

OBJECTIVE: To determine whether, in performing palatoplasty, fracture of the pterygoid hamulus is beneficial, detrimental, or neutral with respect to intraoperative and perioperative complications, hearing outcome, and speech outcome. DESIGN: Prospective, alternating. SETTING: Institutional, tertiary cleft palate center, Chang Gung Memorial Hospital, Taipei, Taiwan. PARTICIPANTS: A total of 173 patients enrolled in the study, of whom 161 had charts available for analysis. INTERVENTIONS: During the performance of palatoplasty, 85 patients received hamulus fracture and 76 patients did not. All palatoplasties were performed by the same surgeon. MAIN OUTCOME MEASURES: (1) Surgical outcomes, including patient demographic data, palatoplasty type and duration, blood loss, incidences of oronasal fistulae, temporary mucosal dehiscence, and postoperative bleeding; (2) otolaryngological outcomes, including hearing results as judged by auditory brainstem response testing, myringotomy tube data describing rates of tube extrusion, and culture results from sampled effusions; and (3) preliminary speech outcomes as described by judgments of overall velopharyngeal function from perceptual speech samples. RESULTS: No statistically significant differences in any of the measured surgical, otolaryngological, or preliminary speech outcomes were found between the groups who did and did not receive hamulus fracture. CONCLUSIONS: On the basis of these results, we are unable to advocate the performance of hamulus fracture as an operative maneuver during the performance of primary palatoplasty. The historical rationale and theoretical advantage of this maneuver have not been demonstrated here nor have any detrimental effects of the maneuver been measured.


Asunto(s)
Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Hueso Esfenoides/cirugía , Distribución de Chi-Cuadrado , Potenciales Evocados Auditivos del Tronco Encefálico , Pruebas Auditivas , Humanos , Lactante , Complicaciones Intraoperatorias , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Orales/estadística & datos numéricos , Otitis Media con Derrame/etiología , Otitis Media con Derrame/microbiología , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias , Cuidados Preoperatorios , Estudios Prospectivos , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Medición de la Producción del Habla
8.
Cleft Palate Craniofac J ; 37(5): 512-5, 2000 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11034036

RESUMEN

OBJECTIVE: Cleft lip and palate is among the most common congenital anomalies. Its association with major blood disorders has rarely been reported. The purpose of this study was to report two patients who had major blood diseases associated with cleft lip and palate. PATIENTS AND RESULTS: From June 1995 to December 1997, there were 2700 patients with cleft lip, cleft palate, or both who received treatment at Chang Gung Memorial Hospital. Two of them were found to have major hematological disorders. In both cases, the disorder was detected by preoperative blood cell counts and white cell differentiation. Case 1 was a 21-year-old woman patient with repaired right cleft lip. She was admitted for alveolar bone grafting and closure of oronasal fistula. Abnormal presentation of blast cells was found, and subsequent bone marrow study confirmed acute lymphocytic leukemia. Case 2 was a 26-year-old man with left secondary cleft lip nasal deformity scheduled to receive staged reconstructive operations. An elevated platelet count was found and subsequently confirmed to represent essential thrombocytosis. In both cases, reconstructive operations for the cleft-related deformities were performed. CONCLUSIONS: Association of major hematological disorders and cleft lip, palate, or both is rare and is reported herein.


Asunto(s)
Fisura del Paladar/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Trombocitosis/complicaciones , Adulto , Proceso Alveolar/anomalías , Recuento de Células Sanguíneas , Trasplante Óseo , Labio Leporino/complicaciones , Contraindicaciones , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Humanos , Masculino , Nariz/anomalías , Procedimientos Quirúrgicos Orales
9.
Plast Reconstr Surg ; 106(5): 1162-74; discussion 1175-6, 2000 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11039388

RESUMEN

This study was undertaken to quantify the path of the inferior alveolar nerve in the normal human mandible and in the mandibles of patients presenting for cosmetic reduction of the mandibular angles. The goals were: (1) to provide normative information that would assist the surgeon in avoiding injury to the nerve during surgery; (2) to characterize gender differences in the normal population; and (3) to compare the course of the nerve in the normal population to its course in a group of patients who presented with a complaint of "square face." The study was based upon the computerized tomographic scans of 10 normal patients (six men, four women) and 8 patients (all women) complaining of "square face." Using AnalyzePC 2.5 imaging software, the mandibles were segmented and the position of the nerve was recorded within its osseous canal in the mandibular ramus on each axial slice in which it was identifiable. Distances were calculated between the nerve and the anterior, posterior, lateral, and medial cortices. The positions of the lateral ramus prominence and the lowest point on the sigmoid notch were also recorded. The position of the mental foramen was recorded in relation to the nearest tooth, and the three-dimensional surface distances from the foramen to the alveolar bone, the inferior border of the mandible, and the mandibular symphysis were determined. The distances from the entrance of the nerve into the mandible to the lateral ramus prominence and the lowest point on the sigmoid notch were calculated. Summary statistics were obtained, comparing differences in gender. The nerve was identifiable in each ramus over a mean distance of 12.7 mm. On average, the lateral ramus prominence was 0.3 mm higher on the caudad-cephalad axis than the point at which the nerve entered the bone, whereas the location of the lowest point on the sigmoid notch was 16.6 mm above the nerve. The average distances from the nerve to the anterior, posterior, medial, and lateral cortices were 11.6, 12.1, 1.8, and 4.7 mm, respectively. Gender differences were significant for all of these except the medial cortex to nerve distance. On average, the mental foramen exited the body of the mandible immediately below the second premolar and the average surface distances from the foramen to the symphysis, the most cephalad alveolar bone, and the inferior border of the body were 30.9, 14.2, and 19.3 mm, respectively. With regard to the patients presenting for mandibular angle reduction, there were a few statistically significant but small scalar differences from normal controls.


Asunto(s)
Mandíbula/inervación , Cirugía Plástica , Adolescente , Adulto , Cefalometría , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Tomografía Computarizada por Rayos X
10.
Changgeng Yi Xue Za Zhi ; 22(3): 378-85, 1999 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-10584408

RESUMEN

BACKGROUND: Palate surgery at an early age may cause retardation of maxillary growth. The second intention healing of the raw bone surface created on the palate is considered to be the cause of the growth retardation. The animal experiment in this study was designed to evaluate this effect. METHODS: Four-week-old Sprague-Dawley rats were divided into 3 groups. In the first group, a strip of mucoperiosteum was excised on both sides of the hard palate. A second group of rats received a sham surgery in which bilateral mucoperiosteal flaps were raised and redraped. The third group served as controls with no surgery. Flap elevation with and without excision was performed under an operative microscope to facilitate the delicate manipulation of tissue and to avoid injury to the underlying bone. The animals were killed 11 weeks later and the skulls were prepared for measurements, which included the palatal inter-molar width, maxillary height, and maxillary length. RESULTS: The results revealed statistically significant decreases in palatal width and maxillary length in the experimental group (excision of mucoperiosteum). No differences were observed in the vertical height of the maxilla. CONCLUSION: This study confirms that surgically created bone denudation of the palate causes maxillary growth disturbances.


Asunto(s)
Maxilar/crecimiento & desarrollo , Hueso Paladar/cirugía , Animales , Peso Corporal , Masculino , Ratas , Ratas Sprague-Dawley
11.
Ann Plast Surg ; 43(3): 258-64, 1999 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-10490176

RESUMEN

Airway obstruction is frequent in patients with severe syndromic craniosynostosis, and must be treated for successful, complete care. The purpose of this study was to evaluate the incidence and the management of airway obstruction in patients with severe craniosynostosis. All patients with complex syndromic craniosynostosis at Chang Gung Craniofacial Center were evaluated retrospectively. Criteria for inclusion of patients were the presence of adequate follow-up and documentation. A total of 40 patients were included, of whom 13 had Apert's syndrome and 27 had Crouzon's disease. Clinical symptoms and signs related to airway obstruction and its treatment were evaluated carefully, and were verified further by telephone inquiry. The status of the airway was categorized into one of three groups: no obstruction; mild obstruction, for which positioning and medical treatment were needed; and severe obstruction, for which surgical intervention was needed. The results showed that 24 patients (60%) did not have airway obstruction, 11 patients (27.5%) had mild obstruction, and 5 patients (12.5%) had severe obstruction. There was no significant difference in the distribution of airway status between patients with Apert's syndrome and Crouzon's disease. Causes for the 5 patients with severe obstruction were midface hypoplasia, lower airway obstruction, tonsillar and adenoid hypertrophy, and choanal atresia. Tracheostomy was performed to control airway in 3 patients, and 1 patient died. Midface anterior distraction helped to decannulate 1 patient. In conclusion, airway obstruction was observed in 40% of patients with severe craniosynostotic syndromes. Most of them could be managed successfully with conservative or medical treatment, and surgical intervention should be considered on the basis of each patient's individual condition.


Asunto(s)
Acrocefalosindactilia/complicaciones , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Disostosis Craneofacial/complicaciones , Adulto , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
12.
Plast Reconstr Surg ; 103(7): 1826-34, 1999 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-10359241

RESUMEN

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; range, 0.5 to 4 mm). In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased S-N-ANS angle with increased alveolar cleft width.


Asunto(s)
Labio Leporino/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Nariz/anomalías , Nariz/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cefalometría , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Humanos , Lactante , Cráneo/diagnóstico por imagen
13.
Ann Plast Surg ; 42(6): 581-8, 1999 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-10382792

RESUMEN

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (T1) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from T1 to T4. Narrowing of alveolar cleft width (Ca) from T1 to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Desarrollo Maxilofacial , Distribución de Chi-Cuadrado , Labio Leporino/patología , Fisura del Paladar/patología , Arco Dental/patología , Femenino , Humanos , Lactante , Masculino , Maxilar/patología , Modelos Dentales , Procedimientos Quirúrgicos Orales , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Resultado del Tratamiento
14.
Plast Reconstr Surg ; 102(7): 2310-9, 1998 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9858164

RESUMEN

The Le Fort I, split-palate approach provides intraoral surgical access to a region of the midline skull base ranging from the upper clivus to the second cervical vertebra. Although this approach provides perhaps the largest exposure of all the intraoral techniques, there is little concerning it in the literature. Furthermore, there are no detailed descriptions of case histories, complications, and outcome. The purpose of this study was to evaluate this procedure's effectiveness and identify associated complications as well as outcome. Seven cases of patients who underwent eight skull base surgeries using the Le Fort I, split-palate approach were evaluated retrospectively. Particular attention was paid to postoperative occlusion, speech, mouth opening, infection, tumor recurrence, postoperative recovery period, and viability of maxillary bone and teeth. Follow-up ranged from 4 months to 7 years with a mean of 3.9 years. Pathologic diagnoses included three chordomas (two recurrent), one recurrent meningioma, one liposarcoma, one chondrosarcoma, and one inflammatory mass. One patient with chordoma underwent a second operation using the same approach. No deaths or major neurologic problems related to the procedure occurred. One patient who had known local metastases at the time of operation died several months after surgery. All other patients are still living. Duration of hospital stay ranged from 5 to 53 days with a mean of 25.4 days. Postoperative complications included one case of meningitis with an associated cerebrospinal fluid leak, three cases of malocclusion, one case of velopharyngeal insufficiency, and one extracranial soft-tissue infection. The case of meningitis was successfully treated by antibiotics. The malocclusions were corrected by conservative treatment. No problems with mouth opening or bone or tooth viability occurred. Tumor recurred in both cases in which malignancy was involved, whereas only one recurrence was noted among the benign cases. It is concluded that the Le Fort I-palatal split technique is a relatively safe and effective means for approaching midline skull base tumors. Several modifications to the surgical protocol and surgical technique are detailed herein.


Asunto(s)
Neoplasias de la Base del Cráneo/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Resultado del Tratamiento
15.
Plast Reconstr Surg ; 99(4): 990-7; discussion 998-9, 1997 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-9091944

RESUMEN

The relationship between the bone and muscles of mastication in hemifacial microsomia was studied using three-dimensional volumetric computed tomography scans and image processing techniques. High resolution head computed tomography scans were obtained from 31 patients with unilateral hemifacial microsomia and eight normal patients. Using three-dimensional volume renderings of bone, mandibular deformities in patients with hemifacial microsomia were classified using the Pruzansky system. For each patient, specific craniofacial bones (temporal bone, maxilla mandible) and the muscles of mastication (masseter, temporalis and lateral and medial pterygoid) were segmented bilaterally from the image volume for independent display and volume measurement. Volumes were expressed as the ratio of the affected: unaffected sides. For the masseter and temporalis, the relationship between muscular hypoplasia and osseous hypoplasia in its origin and insertion was studied by plotting affected:unaffected bone volume as a function of affected:unaffected muscle volume for each muscle, bone of origin, bone of insertion triplet. The volumes of the pterygoid muscles were compared with hemimandibular volumes. The precision of object segmentations was examined by repetitive definition tasks, whereas the accuracy of volume measurement was tested by scanning custom-made phantom objects and comparing digital to physical object volume measurements. Volume measurements performed using these techniques were both accurate and precise. In hemifacial microsomia, the extent of hypoplasia of specific muscles of mastication predicted the extent of dysplasia in their osseous origin and insertion. However, the reverse was not true. The extent of hypoplasia of the facial bones did not necessarily predict the extent of hypoplasia in the attached muscles of mastication. Pruzansky grade of the mandible described the degree of mandibular hypoplasia on the affected side, but was inconsistent in its prediction of volume decrease of the other facial bones.


Asunto(s)
Asimetría Facial/diagnóstico por imagen , Huesos Faciales/diagnóstico por imagen , Músculos Masticadores/diagnóstico por imagen , Asimetría Facial/patología , Huesos Faciales/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Músculos Masticadores/patología , Maxilar/diagnóstico por imagen , Maxilar/patología , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/patología , Tomografía Computarizada por Rayos X , Cigoma/diagnóstico por imagen , Cigoma/patología
16.
Ann Plast Surg ; 39(6): 624-7, 1997 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9418923

RESUMEN

Infantile myofibromatosis is a rare disease characterized by myofibroblastic proliferation, and typically occurs in early infancy. There is a wide spectrum of clinical presentation, which may involve various kinds of tissues in the body. Skin and subcutaneous lesions were the types of tissue most often seen. Although a multicentric form may behave aggressively, a solitary form of the tumor is benign with the possibility of spontaneous regression. Conservative management is justified after proper pathological diagnosis if the tumor involves an aesthetically important area. A case of solitary infantile myofibromatosis involving the upper lip is presented. Partial excision for biopsy was performed and long-term observation was undertaken. The tumor disappeared 3 years postoperatively.


Asunto(s)
Neoplasias de los Labios/patología , Miofibromatosis/patología , Actinas/análisis , Biomarcadores de Tumor/análisis , Biopsia , Humanos , Lactante , Neoplasias de los Labios/diagnóstico , Neoplasias de los Labios/cirugía , Masculino , Miofibromatosis/diagnóstico , Miofibromatosis/cirugía , Regresión Neoplásica Espontánea , Vimentina/análisis
17.
Plast Reconstr Surg ; 98(3): 393-405; discussion 406-9, 1996 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-8700973

RESUMEN

Fronto-orbital dysmorphology in nonsyndromic bilateral coronal synostosis includes frontal flattening, supraorbital recession, and ocular globe protrusion. Surgical advancement of the supraorbital region ("bandeau") is performed to correct these deformities. A retrospective analysis of 10 consecutive patients with nonsyndromic bilateral coronal synostosis was performed to assess the effect of two types of bandeau fixation at the nasion. The advanced bandeau was fixed medially at the nasion with a calvarial bone graft and polyglycolic acid sutures (bone graft/suture group, five patients) or with a microplate (plate group, five patients) and bilaterally at pterion with calvarial bone grafts and polyglycolic acid sutures (all patients). The cranio-orbital dysmorphology and the surgical results were studied using pre-, peri-, and post-operative three-dimensional computed tomographic (CT) data. Reformation, manipulation, editing, and quantitative measurements of the CT data were performed on a computer workstation and Analyze imaging program. Four measurements performed to evaluate the fronto-orbital morphology: the length:width ratio of anterior cranial fossa, ventral globe index, cornea position, and supraorbital rim lag. The ventral globe index assessed the degree of eyeball protrusion out of the orbit cavity. Measurements of the cornea position and supraorbital rim lag were performed on the longitudinal orbit projections of the CT data. Six normal skull CT scans were available for same measurement and comparison. Measurements of the preoperative fronto-orbital dysmorphology in bilateral coronal synostosis were significantly different from those of normal subjects. One year after the surgery, the length:width ratio of the anterior cranial fossa was normalized in both groups. The ventral globe index was improved but not normalized in both groups, whereas the cornea position and supraorbital rim lag were improved in the bone graft/suture group but were normalized in the plate group. Based on the quantitative data, the surgical outcomes in the plate group were significantly better than those in the bone graft/suture group. Major relapse of surgical advancement in the bone graft/suture group seemed to occur in perioperative period. In summary, at 1 year postoperatively, the bandeau advancement improved but did not entirely normalize the fronto-orbital dysmorphology of nonsyndromic bilateral coronal synostosis in either group. We conclude that plate rigid fixation at the nasion provides superior stability for bandeau advancement compared with bone graft/suture fixation.


Asunto(s)
Disostosis Craneofacial/diagnóstico por imagen , Disostosis Craneofacial/cirugía , Osteotomía , Cráneo/diagnóstico por imagen , Cráneo/cirugía , Tomografía Computarizada por Rayos X , Placas Óseas , Trasplante Óseo , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
18.
Cleft Palate Craniofac J ; 33(3): 190-7, 1996 May.
Artículo en Inglés | MEDLINE | ID: mdl-8734717

RESUMEN

Unilateral coronal synostosis (UCS) produces overt craniofacial dysmorphology. UCS surgery in infancy aims to release the osseous restriction and normalize the fronto-orbital deformity. The quantitative effect of this surgery on the orbit and its contents is unknown. This study was conducted to quantify the preoperative orbital dysmorphology and its surgical outcome in patients with unilateral coronal synostosis. Twenty-eight UCS patients had preoperative three-dimensional computerized tomographic (CT) scans (at mean age 4.0 months), cranio-orbital reconstructive surgery (at 4.7 months), and postoperative scans (at 18.1 months). The CT data were analyzed using a computer workstation and AnalyzeTM biomedical imaging software. Four measurements were performed on both ipsilateral (same side as synostosis) and contralateral (opposite to synostosis) orbits of each scan: orbital index (OI, 100 x height/width of orbit), orbital cavity volume (OV), ocular globe volume (GV), and ventral globe Index (VGI, 100 x globe volume ventral to the anterior surface of orbital cavity/GV). The data were analyzed for statistical significance using Student's ttest. Preoperatively, the OI was significantly greater on the ipsilateral than on the contralateral side (113.7 vs. 87.3). There was a significant improvement on both sides of the orbit postoperatively, with ipsilateral 99.1 and contralateral 92.1. However, the difference between both sides remained significant. The OV was smaller in the ipsilateral orbits both pre- and postoperatively, with ipse/contralateral ratios of 95.8 and 95.2, respectively. Importantly, the GV was consistently smaller in the ipsilateral orbits preoperatively, with an ipse/contralateral ratio of 93.3. The ratio increased to 97.1 postoperatively, a statistically significant change. In the ipsilateral orbits, the preoperative VGI was significantly greater. The VGI improved postoperatively. These data indicate that UCS affects the development of the osseous orbit as well as its soft-tissue contents. After cranio-orbital surgery, there is diminution of asymmetry of both the bony orbit and its soft-tissue contents. Partial normalization of orbital dysmorphology occurred during the first postoperative year. UCS surgery in infancy does not prevent growth of orbital hard or soft tissues, and it seems to permit normalization of previously impaired growth.


Asunto(s)
Craneosinostosis/cirugía , Craneotomía/efectos adversos , Hueso Frontal/patología , Desarrollo Maxilofacial , Órbita/patología , Cefalometría/métodos , Ojo/crecimiento & desarrollo , Ojo/patología , Femenino , Hueso Frontal/diagnóstico por imagen , Hueso Frontal/crecimiento & desarrollo , Humanos , Lactante , Masculino , Órbita/diagnóstico por imagen , Órbita/crecimiento & desarrollo , Evaluación de Resultado en la Atención de Salud , Tomografía Computarizada por Rayos X
19.
Plast Reconstr Surg ; 97(2): 282-91, 1996 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-8559810

RESUMEN

Plagiocephaly is a descriptive term that connotes an asymmetrically oblique or twisted head. Such cranial dysmorphology has a number of etiologies, the most common of which are unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Use of the term plagiocephaly in the literature is often ambiguous in that at times it is used inclusively for all etiologies while at other times it is used exclusively as a synonym for unicoronal synostosis. Although differentiation by physical examination among unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis usually is possible for an experienced observer, inexperienced observers often have difficulty making an anatomically accurate diagnosis even with the assistance of conventional skull radiographs. High-resolution CT scans, including three-dimensional osseous surface re-formations, have become a standard element in the evaluation of craniofacial anomalies in many centers. We hypothesized that the three major etiologies of plagiocephaly could be unambiguously differentiated by means of endocranial three-dimensional CT osseous surface re-formations. Archival pretreatment CT data on 15 unicoronal synostosis, 4 unilambdoid synostosis, and 15 plagiocephaly without synostosis patients were reviewed to define, qualitatively and quantitatively, the characteristics of the endocranial base morphologies for each group; in addition to visual dysmorphology specific to each group, there was a statistically significant difference in the angle of deviation from the midlines of the anterior and posterior cranial fossae among unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Four radiologists experienced in reading images of craniofacial anomalies were oriented to the group characteristics and then instructed to perform differential diagnosis for each of the 34 patients using only the endocranial three-dimensional CT images. The raters were blind to all other clinical and diagnostic information. The raters correctly diagnosed unicoronal synostosis. Errors were made in differentiation of unilambdoid synostosis and plagiocephaly without synostosis. These errors resulted from the raters' reliance on image inspection rather than quantitation of anteroposterior fossae midline angulation. Such quantitation unambiguously differentiated between unilambdoid synostosis and plagiocephaly without synostosis in the "error" cases. The endocranial base dysmorphology of patients with plagiocephaly is etiology-specific for unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Three-dimensional CT endocranial base images can assist differential diagnosis of plagiocephaly.


Asunto(s)
Cráneo/anomalías , Cefalometría , Anomalías Congénitas/diagnóstico por imagen , Anomalías Congénitas/patología , Craneosinostosis/complicaciones , Craneosinostosis/diagnóstico por imagen , Craneosinostosis/patología , Diagnóstico Diferencial , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Cráneo/diagnóstico por imagen , Cráneo/patología , Tomografía Computarizada por Rayos X
20.
Clin Plast Surg ; 21(4): 501-16, 1994 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-7813151

RESUMEN

Computer-assisted planning and simulation of craniofacial surgery has progressed from development, through validation, and into clinical use. CT scans are transferred from the radiology department to a graphics workstation in the surgeon's office or laboratory, where data postprocessing and visualization for anatomic evaluation and surgical simulation are performed. Quantitative and qualitative comparative analyses between the plan/simulation and the actual postoperative result provide the feedback that validates or refutes the preoperative assessment and simulated intervention. The optimum surgical solution can be chosen from many possibilities. Interactive computer-assisted surgical simulation is also useful for morbidity-free training of inexperienced surgeons.


Asunto(s)
Simulación por Computador , Huesos Faciales/anomalías , Huesos Faciales/cirugía , Modelos Biológicos , Planificación de Atención al Paciente , Cráneo/anomalías , Cráneo/cirugía , Terapia Asistida por Computador , Niño , Preescolar , Retroalimentación , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Reproducibilidad de los Resultados
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA