Machine learning-based decision support system for orthognathic diagnosis and treatment planning.

BACKGROUND: Dento-maxillofacial deformities are common problems. Orthodontic-orthognathic surgery is the primary treatment but accurate diagnosis and careful surgical planning are essential for optimum outcomes. This study aimed to establish and verify a machine learning-based decision support system for treatment of dento-maxillofacial malformations. METHODS: Patients (n = 574) with dento-maxillofacial deformities undergoing spiral CT during January 2015 to August 2020 were enrolled to train diagnostic models based on five different machine learning algorithms; the diagnostic performances were compared with expert diagnoses. Accuracy, sensitivity, specificity, and area under the curve (AUC) were calculated. The adaptive artificial bee colony algorithm was employed to formulate the orthognathic surgical plan, and subsequently evaluated by maxillofacial surgeons in a cohort of 50 patients. The objective evaluation included the difference in bone position between the artificial intelligence (AI) generated and actual surgical plans for the patient, along with discrepancies in postoperative cephalometric analysis outcomes. RESULTS: The binary relevance extreme gradient boosting model performed best, with diagnostic success rates > 90% for six different kinds of dento-maxillofacial deformities; the exception was maxillary overdevelopment (89.27%). AUC was > 0.88 for all diagnostic types. Median score for the surgical plans was 9, and was improved after human-computer interaction. There was no statistically significant difference between the actual and AI- groups. CONCLUSIONS: Machine learning algorithms are effective for diagnosis and surgical planning of dento-maxillofacial deformities and help improve diagnostic efficiency, especially in lower medical centers.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Binder's syndrome: A narrative review.

AIM: The classical features of Binder's syndrome (BS) have been widely reported, yet there is a lack of information on diagnostic and treatment challenges. Therefore, we aimed to review the literature on various aspects, including the role of a multidisciplinary approach in the management of BS. METHODS: A thorough literature search was performed on PubMed, Scopus, Embase, Ovid, Web of Science, EBSCOhost, and Google Scholar using the keywords"Maxillonasal dysplasia", "Maxillonasal dysostosis", "nasomaxillary hypoplasia", "Binder type", "Binder syndrome", "Binder phenotype", and "OMIM 155050". In addition, the articles published in the English language from the inception of the database until June 2021 were considered. RESULTS: The search of different databases yielded 958 publications, out of which 145 relevant articles were reviewed. The studies were categorised by year of publication, study design, and theme. Most of the studies were case reports (42%) followed by case series (19%). The most reported topic was based on different surgical techniques (42%). Finally, the results were synthesised into a narrative review. CONCLUSIONS: The need for a multidisciplinary approach involving clinicians from different specialities is highlighted. Future research is warranted to develop concrete clinical guidelines for the management of this syndrome.

Early surgical intervention for nasal deformity in Binder's syndrome.

OBJECTIVE: To assess benefits of surgical intervention at an early age and focus on surgical techniques using exclusively autologous cartilage grafts. METHODS: Five children aged 8-15 years, treated between March 2016 and 2020, underwent augmentation rhinoplasty using autologous cartilage, with post-operative follow up ranging from 1.5 to 2 years. Photographs and Rhinoplasty Outcome Evaluation questionnaire scores were examined. RESULTS: Augmentation was achieved without complications. No restricted skin or mucosal pockets were encountered. Patients showed improved confidence and perspective with regard to self-image, and were less socially self-conscious. There was significant improvement in all Rhinoplasty Outcome Evaluation questionnaire scores. CONCLUSION: Early surgery allows augmentation with easier release of skin and mucosal pockets, and without the tension otherwise encountered if primary augmentation is performed at a later age. It offers a chance to improve confidence and self-perception in a growing child conscious about their appearance, which may make them socially withdrawn. Autologous cartilage gives better results than bone grafts, and is comparable with silicone but without its complications.

Surgical Treatment for Patients With Binder Syndrome, Clinical Features and Associated Symptoms: A Systematic Review.

BACKGROUND: Binder syndrome is a rare congenital malformation of the midface. Since 1990, no systematic review has been conducted on this condition. Our study aims to review and collect the surgical treatment options available for correcting nasomaxillary dysplasia and the information available in the international literature on Binder syndrome and associated symptoms. METHODS: This systematic literature review was registered in the PROSPERO (International Prospective Register of Systematic Reviews) database. Systematic literature searches were performed in Medline, Scopus, the Cochrane Library, and Web of Science databases. Study quality assessment was performed according to recommendations from the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. RESULTS: The authors identified 200 articles from our database research. One hundred sixty-nine articles were excluded after the title and abstract screening. Seven articles were excluded after screening the full text. In total, 24 clinical studies were included: 14 studies aim to describe a surgical option and 10 articles treat information about Binder syndrome or associated features. Most of the studies (12/14 studies) performed rhinoplasties to treat nasomaxillary dysplasia. The 2 other articles evaluated maxillary osteotomy techniques. Only 3 articles compared the results obtained from different surgical techniques. CONCLUSIONS: No optimal surgical treatment plan has been developed, even if numerous surgical options are available. Etiology is still uncertain.

Our Strategy in Management of Maxillonasal Dysplasia in Pediatric Patients.

ABSTRACT: Maxillonasal dysplasia or Binder syndrome is an uncommon condition. It is a congenital disease characterized by undergrowth of the central face and may include elements of the nose and upper jaw. The hallmark of the deformity is a retruded mid-face and an extremely flat nose. The timing and the surgical approaches for management of such deformity are still controversial. In this paper, we are going to present our experience in management of Binder syndrome in children. Seven children ranging in age from 6 to 13 years with classic features of Binder syndrome were operated upon in this study. The surgical approach was done at an early age and included 3 main components; nasal dorsum augmentation by costal cartilage graft, maxillary augmentation by rib grafts and columellar reconstruction by VY-plasty and strut grafts. Patients were followed for up to 6 years. Excellent results were obtained in all patients with this surgical procedure. Half of our patients required more than 1 surgery but none of them required any secondary orthognathic surgery. Therefore, we recommend that children with Binder syndrome should be managed at an early age at least for correction of their nasal deformities. Maxillary augmentation can also be done simultaneously or delayed for a second stage. During the second stage, further nasal augmentation can be accomplished. Definitive orthognathic surgeries have to be postponed to adolescence. This strategy can dramatically improve the patient aesthetic and alleviate the psychological upset without much disturbance of the facial growth.

Dinámica relacionada con la edad de parámetros antropométricos craneofaciales y su asociación con el tipo de oclusión dental en seres humanos de ambos géneros de: 17 a 24 años / Age-related dynamics of craniofacial anthropometric parameters and their association with the type of dental occlusion in humans of both genders aged 17­24 years

El propósito del estudio fue analizar la dinámica de los cambios relacionados con la edad de las estructuras craneofaciales de acuerdo con los parámetros antropométricos en hombres y mujeres de 17 a 24 años, y determinar la correlación, definida por análisis antropométrico, entre las formas de morfología craneofacial y los tipos de anomalías dento-maxilares. Materiales y métodos: Se realizó un examen antropométrico de 851 individuos (418 hombres y 433 mujeres) de 17 a 24 años y la evaluación de 45 mediciones entre puntos de referencia de tejidos blandos. Además, se realizó una valoración odontológica general, que incluyó la clasificación de las anomalías dentomaxilares. Resultados: Se detectó que el ancho de la cabeza, el largo de la cabeza, así como el ancho de la mandíbula y el ancho morfológico facial en las hembras alcanzan valores máximos de crecimiento a la edad de 20 años. Además, se obtuvieron datos que indicaron la continuación del crecimiento de los parámetros antropométricos craneofaciales mencionados anteriormente en los hombres durante el período de transición de la adolescencia a la edad adulta. Conclusión: la mordida profunda distal es la anomalía dento-maxilar (DMAn) más común en hombres y mujeres bielorrusos de 17 a 24 años. Junto con esto, la frecuencia de ocurrencia de maloclusión de mordida profunda distal en individuos con morfología craneofacial dolicocefálica es mayor en hombres y mujeres en comparación con otras formas de morfología craneofacial. La mordida profunda distal se acompaña de la disminución de los parámetros antropométricos de la altura facial, en comparación con la mordida mesial y abierta en la que hay un aumento estadístico. Además, se observa una disminución estadística en el valor de la profundidad facial inferior en individuos diagnosticados con mordida distal, en comparación con individuos con mordida mesial y normal. Estos resultados obtenidos del análisis antropométrico podrían ser útiles en el diagnóstico de anomalías dentofaciales y dento-maxilares, y en la simulación de resultados de tratamiento estéticamente estables.

The purpose of the study was to analyze the dynamics of age-related changes of craniofacial structures according to anthropometric parameters in males and females aged 17­24 years, and to determine the correlation, defined by anthropometric analysis, between forms of craniofacial morphology and the type of dento-maxillary anomalies. Materials and Methods: An anthropometric examination of 851 individuals (418 males and 433 females) aged 17­24 years and the evaluation of 45 measurements between soft tissue landmarks was performed. In addition, general dental assessment was conducted, which included the classification of the dento-maxillary anomalies. Results: It was detected that the head width, head length, as well as the mandible width, and the morphological facial width in females reach growth peak values at the age of 20 years. Furthermore, data was obtained which indicated growth continuation of the stated above craniofacial anthropometric parameters in males during the transitional period from adolescence to adulthood. Conclusion: Distal deep bite is the most commonly prevailed dento-maxillary anomalies (DMAn) in Belarusian men and women aged 17­24 years. Along with this, the frequency of distal deep bite malocclusion occurrence in individuals with dolichocephalic craniofacial morphology is higher in men and women when compared to other forms of craniofacial morphology. Distal deep bite is accompanied by the decrease of facial height anthropometric parameters, when compared to mesial and open bite in which there is a statistical increase. Moreover, a statistical decrease in the value of the inferior facial depth is observed in individuals diagnosed with distal bite, when compared to individuals with mesial and normal bite. These obtained results from anthropometric analysis could be useful in diagnosis of dentofacial and dento-maxillary anomalies, and in the simulation of aesthetically stable treatment results

Alternativas terapéuticas para el síndrome de apnea e hipoapnea obstructiva del sueño en niños con anomalías intermaxilares sagitales o transversales: Revisión narrativa / Therapeutic alternatives for obstructive sleep apnea syndrome in children with sagittal and transverse intermaxillary anomalies: Narrative review

RESUMEN: Introducción: El síndrome de apnea e hipoapnea obstructiva del sueño corresponde a un trastorno respiratorio del sueño muy prevalente en niños. Muchas alternativas terapéuticas buscan controlar los factores desencadenantes y la progresión de los signos y síntomas. El objetivo de esta revisión es describir los efectos de los tratamientos para síndrome de apnea e hipoapnea del sueño en niños con anomalías intermaxilares sagitales o transversales. Material y método: Se realizó una búsqueda electrónica en las bases de datos: PubMed, Epistemónikos, EBSCO, TripDataBase y The Cochrane Library, con las palabras clave: "Obstructive sleep apnea", "Obstructive sleep apnoea", "Sleep apnea syndrome", "Sleep apnoea syndrome", "Sleep apnea", "Sleep apnoea", "hypoapnea", "OSA", "Treatment", "Therapy", "Children", "Pediatric", "Craniofacial abnormalities", "Craniofacial anomalies", "Craniofacial abnormality", "Orthodontic" y una búsqueda retrógrada en los textos seleccionados. Resultados: Se incluyeron 23 artículos; 12 ensayos clínicos, 6 revisiones sistemáticas, 1 estudio observacional y 4 revisiones narrativas. Conclusión: Los tratamientos ortopédicos para el síndrome de apnea e hipoapnea son la expansión rápida maxilar y dispositivos de avance mandibular. No se encontró suficiente evidencia para determinar que estos dispositivos resuelvan completamente el síndrome, pero disminuyen el índice de apnea e hipoapnea y sus signos y síntomas.

ABSTRACT: Introduction: Obstructive sleep apnea and hypoapnea syndrome refers to a respiratory sleep disorder with an increased prevalence among children. There are many therapeutic alternatives, focused on controlling trigger factors and the signs and symptoms progression. The objective of this review is to describe the effects of the available treatments for sleep apnea and hypoapnea syndrome in children with sagittal and transverse intermaxillary anomalies. Materials and Method: An electronic search was performed in PubMed database, Epistemonikos, EBSCO, Tripdatabase, and The Cochrane Library, using the keywords "Obstructive sleep apnea", "Obstructive sleep apnoea", "Sleep apnea syndrome", "Sleep apnoea syndrome", "Sleep apnea", "Sleep apnoea", "hypoapnea", "OSA", "Treatment", "Therapy", "Children", "Pediatric", "Craniofacial abnormalities", "Craniofacial anomalies", "Craniofacial abnormality" and "Orthodontic". Also, a retrieval search in the selected articles references was performed. Results: 23 articles were included; 12 clinical trials, 6 systematic reviews, 1 observational study and 4 narrative reviews. Conclusion: There are two types of orthopedic treatment for sleep apnea and hypoapnea syndrome in children with sagittal and transverse intermaxillary anomalies: rapid maxillary expansion and mandibular advancement devices. There was not enough evidence to determine that these devices achieve the syndrome's complete resolution. An important decrease in the apnea and hypoapnea index and signs and symptoms were observed.

Comprehensive correction of maxillofacial bone deformity-consideration and combined application of orthognathic surgery and facial contouring surgery.

The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.

[Obstructive sleep apnea in microtia children with maxillofacial dysostosis].

Children with microtia are often associated with maxillofacial dysostosis, such as Treacher Collins syndrome, Goldenhar syndrome, and Nager syndrome, and they are prone to suffer from obstructive sleep apnea（OSA）. Obstruction widely occurred in the upper airway is the main mechanism of OSA in these children, and dysplasia of the pharynx and neurodevelopmental abnormalities may also participate. Early diagnosis requires symptom screening and polysomnography. Imaging techniques and endoscopy can be adopted to fully assess the upper airway status to guide further treatment. According to the child's condition and the main obstruction site, treatment methods include maxillofacial deformity correction, continuous positive pressure ventilation and tracheotomy. OSA in microtia children with maxillofacial dysostosis needs to be identified and treated in time to reduce the adverse effects on the growth and development of children.

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática / Piezoelectric bone surgery compared to conventional saw in orthognathic surgery

RESUMEN: Introducción: La utilización de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos en comparación al uso de sierra convencional. Sin embargo, aún existe incertidumbre respecto a las complicaciones asociadas a cada instrumental. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con la sierra convencional podría disminuir el riesgo de daño nervioso grave y disminuir el sangrado grave (>500 mL), pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría presentar poca o nula diferencia en el dolor postoperatorio, pero la certeza de la evidencia es baja. Finalmente no es posible establecer con claridad si el uso de instrumental piezoeléctrico disminuye la pérdida de sangre intraoperatoria (variable continua), la inflamación postoperatoria o el tiempo operatorio, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: The use of piezoelectric bone surgery in orthognathic surgery has been increasing to minimize the risk of soft tissue damage compared to conventional saws. However, there is still uncertainty regarding the complications associated with each instrument. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified four systematic reviews that included 10 primary studies, four of which corresponded to randomized trials. We conclude that the use of piezoelectric instrumentation compared to the conventional saw may reduce the risk of severe nerve damage and decrease severe bleeding (>500 mL), but the certainty of the evidence is low. On the other hand, the use of piezoelectric bone surgery may make little or no difference in postoperative pain, but the certainty of the evidence is low. Finally, we are uncertain whether piezoelectric bone surgery reduces intraoperative blood loss (continuous variable), postoperative inflammation, and operative time, as the certainty of the evidence has been assessed as very low.

Lacrimal drainage anomalies in Tessier cleft 3 with unilateral anophthalmos.

Bilateral Tessier cleft types 3 and 4 are rare and commonly involve the lacrimal drainage system owing to their anatomical location. Such clefts commonly present with associated ocular anomalies and include colobomatous eyelids, hypertelorism, microphthalmia, punctal or canalicular agenesis, and nasolacrimal duct obstruction or exstrophy. The current report presents an 18-month-old baby with bilateral Tessier cleft 3 with a unilateral anophthalmos, symmetrical eyelid colobomas, and lacrimal drainage anomalies. The lacrimal anomalies noted include small lacrimal sac with inferior canaliculus on the right side and upper and lower punctal and canalicular agenesis on the left side. Computed tomographic dacryocystography demonstrated unilateral lacrimal sac and bilateral maldevelopment of the bony nasolacrimal duct.

Interpositional collagenated cancellous bone blocks for nasal dorsum augmentation: A new technique for nasomaxillary hypoplasia treatment.

Nasomaxillary hypoplasia is a rare congenital malformation involving the middle third of the face. The present paper describes a novel technique for restoring the nasal projection in a patient with nasomaxillary hypoplasia, analyses its advantages and limitations, and discusses its potential applicability in other similar contexts. After orthognathic surgery, lateral osteotomies of the nasal bones were performed integrally with a piezoelectric device using a long cutting saw tip through the intraoral approach. The nasal bones were then projected by interpositioning two triangular-shaped collagenated cancellous bone graft blocks on each side in the osteotomies between the nasal and the frontal processes of the maxillary bones. Cone-beam computed tomography (CBCT) data was used to perform a morphometric analysis at one and 12 months of follow-up through image superimposition, which revealed a stable increased projection of the nasal dorsum and an anterior nasal spine (ANS) of 5.18 mm and 5.52 mm, respectively. The results of this case suggest that the technique affords satisfactory nasal dorsum augmentation while avoiding the use of permanent foreign materials, with minimal morbidity, no unsightly and visible scars, great patient satisfaction, and adequate stability at 12 months of follow-up.

Secondary Rhinoplasty in Binder Syndrome: Considerations and Management of Complex Problem With Heterologous Bone Graft.

ABSTRACT: Binder Syndrome occurs in less than 1 per 10,000 live births. Mean features of the syndrome include arhinoid face, abnormal position of the nasal bones, intermaxillary hypoplasia with associated malocclusion, reduced or absent anterior nasal spine, atrophy of the nasal mucosa and absence of the frontal sinus. Treatment of these facial deformities is obviously surgical. In the present work, the authors describe, step by step, their technique in secondary rhinoplasty in a 36-years-old patient affected by Binder Syndrome. In this case, the authors used autologous cartilage graft and heterologous bone graft.Satisfying results are achieved in 12 months of follow-up: graft resorption is acceptable, position of the graft is stable, the authors have no signs of infection and the patient is satisfied with the aesthetical and functional results. The authors believe that the first option, in complex nose's reconstruction, is the use of autologous grafts but, the use of cartilage heterologous bone graft should be taken in account, in the future, as a secondary option in Binder Syndrome and in malformed patients.

Cirugía de la anquilosis temporomandibular en pacientes pediátricos / Temporo mandibular joint ankylosis surgery in pediatric patients

Introducción: la anquilosis temporomandibular se caracteriza por la limitación en la apertura bucal, lo que conlleva alteraciones estéticas, de la masticación, el lenguaje y respiratorias. El objetivo del reporte es describir las características clínicas de los pacientes y evaluar resultados del tratamiento quirúrgico para la anquilosis temporomandibular. Materiales y métodos: presentamos un estudio observacional, descriptivo y retrospectivo en el que se revisaron las historias clínicas e imágenes de todos los pacientes operados de anquilosis de la articulación temporomandibular desde enero 2008 a diciembre de 2016. Resultados: se intervinieron 44 casos, cuya etiología principal eran los traumatismos (70,5 %), con predominio femenino en el 77,3 % de los casos y la presentación unilateral como la más frecuente con el 70,5 % del total. La edad de mayor frecuencia de presentación fue entre 6 a 10 años con el 47,7 % de los casos. La cirugía más realizada fue la condilectomía con coronoidectomía en el 79,5 % de los casos. Como complicación más frecuente se encontró la parálisis de la rama palpebral en el 13,7 %, y obteniendo un 6 % de recidiva. Discusión: los resultados presentados son similares a otras publicaciones, ya que se reprodujo el tratamiento protocolizado mundialmente y no se encontraron diferencias significativas en cuanto a etiología, edad, tratamiento realizado y complicaciones. Conclusiones: la anquilosis temporomandibular es una patología que requiere de un tratamiento quirúrgico que logre la resección del bloque anquilótico, así como la asociación de otras técnicas quirúrgicas como la realización de un colgajo para disminuir la posibilidad de recidiva y distracción ósea para restablecer la anatomía mandibular.

Introduction: Temporomandibular ankylosis limits the mandibular function, decreasing the buccal opening, with aesthetic alterations as well as chewing language and even respiratory disfunction. Objective: To describe the patients clinical paticularities and evaluate the surgical treatment results for this pathology. Design: Observacional, descriptive and retrospective study. Methods: We reviewed the medical histories and images of all the patients who underwent temporomandibular ankylosis release from January 2008 to December 2016. Results: It involved 44 cases, being the main etiology injuries in a 70.5%, with predominance of the female sex in the 77.3% and the unilateral presentation with the 70.5% of the cases. Ages between 6 to 10 years were the most frequent ones with 47.7%. The surgery most performed was the condilectomia with coronoidectomy in 79.5% of the cases. The most frequent complication was the palpebral branch paralysis in 13.7% and we had a 6% of ankylosis recurrence. Discussion: Our results are similar to other publications when reproducing the worldwide protocolized treatment, without finding significant differences in terms of etiology, age of presentation, treatment carried out and complications. Conclusions: Temporomandibular ankylosis is a condition that requires surgical treatment, which is aimed to anatomical and functional restoration. Wide bone resection complemented with other surgical techniques such as flap interposition to minimize the relapse possibility and bone distraction to restore the mandibular anatomy.

Síndrome de Axenfeld-Rieger. Presentación de un caso / Axenfeld-Rieger syndrome. Presentation of a case

RESUMEN El síndrome de Axenfeld-Rieger es una enfermedad de origen genético de muy baja prevalencia que se hace acompañar de manifestaciones clínicas variables con afectación ocular y no ocular. Por tales razones se decidió presentar el caso de una paciente de 14 años de edad, antecedente familiar (en este caso su madre) de dicha enfermedad, con historia de retraso mental ligero, hipoacusia y mala visión en ambos ojos que se acompaña de alteraciones oculares: malformaciones a nivel del segmento anterior: deformidad de la pupila, prominencia blanquecina perilímbica que se corresponde con un embriotoxón posterior. Presenta otros signos de afectación no oculares: dismorfismo craneofacial leve, hipertelorismo, hipoplasia maxilar con aplanamiento del tercio medio facial, frente prominente, puente nasal ancho y aplastado así como anomalías dentales. Sufre complicaciones propias de la evolución de la entidad como es el glaucoma secundario, por lo que se trató con triple terapia con hipotensores oculares, en espera de la respuesta al tratamiento para, en el caso de una evolución tórpida, proceder al tratamiento quirúrgico: trabeculectomía.

ABSTRACT Axenfeld-Rieger syndrome is a very low prevalence disease of genetic origin that is accompanied by variable clinical manifestations with ocular and non-ocular involvement. For these reasons, it was decided to present the case of a 14-years-old patient with a family history (in this case her mother) of this disease, with a history of mild mental retardation, hearing loss and poor vision in both eyes that is accompanied by ocular alterations: malformations at the level of the anterior segment: pupil deformity, perilimbic whitish prominence corresponding to a posterior embryotoxon. He presents other non-ocular signs of involvement: mild craniofacial dysmorphism, hypertelorism, maxillary hypoplasia with flattening of the midface, prominent forehead, wide and flattened nasal bridge, as well as dental anomalies. He suffers from complications inherent to the evolution of the entity, such as secondary glaucoma, for which he was treated with triple therapy with ocular hypotensive agents, pending the response to treatment, and in the case of a torpid evolution, proceed to surgical treatment: trabeculectomy.

Tissue-engineered Maxillofacial Skeletal Defect Reconstruction by 3D Printed Beta-tricalcium phosphate Scaffold Tethered with Growth Factors and Fibrin Glue Implanted Autologous Bone Marrow-Derived Mesenchymal Stem Cells.

The study aimed to investigate whether a 3D printed beta-tricalcium phosphate (ß-TCP) scaffold tethered with growth factors and fibrin glue implanted autologous bone marrow-derived mesenchymal stem cells would provide a 3D platform for bone regeneration resulting in new bone formation with plasticity. Twenty 3D printed ß-TCP scaffolds, ten scaffolds engrained with osteogenic mesenchymal stem cells with fibrin glue (group A), and ten scaffolds used as a control group with ß-TCP scaffold and fibrin glue inoculation only (group B) were included in the study. Cell infiltration, migration, and proliferation of human osteogenic stem cells on the scaffolds were executed under both static and dynamic culture conditions. Each scaffold was examined post culture after repeated changes in the nutrient medium at 2, 4 or 8 weeks and assessed for opacity and formation of any bone-like tissues macroscopic, radiographic, and microscopic evaluation. Significant changes in all the prerequisite parameters compiled with an evaluated difference of significance showing maxillofacial skeletal repair via tissue engineering by ß-TCP scaffold and MSCs remains will be the most promising alternative to autologous bone grafts and numerous modalities involving a variety of stem cells, growth factors from platelet-rich fibrin.