Ocular Hypertelorism: Principles and Management.

Background: Ocular hypertelorism (OH) was initially considered as un-differentiated congenital cranio-facial deformity, however, I.T Jackson mentioned it as teleorbitism, considering it as increase in the inter-canthal width, inter-pupillary as well as inter-orbital distance as a result of lateralization of the orbital complex in total. Furthermore, Sailer further refined it and included the distance from the lateral orbital wall, i.e. he denoted increased inter-orbital distance along with the distance between lateral orbital walls as true hypertelorism. This condition is rare and is seen in association with midline congenital defects affecting the cranio-facial region. Classification and review of cases: The ideal time for the OH correction is usually between 5 and 8 years of age. However, the management of OH is complex, and several techniques have been described in literature for the same. Here, we describe our classification of OH, along with the evolution of the surgical aspects, the key treatment principles we follow, together with the types of the osteotomies and their indications. Furthermore, we delineate the four main principles that we have set for OH management. Results: Though the improvement in appearance is seen immediately post-surgery, however, this challenging surgery faces a multitude and common postoperative complications which have been represented in this article. The surgeon needs both the technical expertise and an inclination towards aesthetics for the execution of such procedures. Conclusion: It is preferred that the management of OH should be individualized as per the stage of the craniofacial growth and the psychosocial needs of the patient and the parents.

Cephalometric analysis of parents of patients with cleft lip and/or palate.

BACKGROUND: Cleft lip and/or palate (CL ± P) or isolated cleft palate (CP) are the most common congenital malformations of the face. Although there have been advances in prenatal diagnosis and the discovery of genetic markers, there has been no breakthrough in the identification of parents at risk of giving birth to a child with a cleft. AIMS: To determine a possible phenotypic difference in the craniofacial morphology of parents of children with CL ± P and to investigate whether cephalometric analysis can help identify parents at risk of giving birth to a child with a cleft. METHODS: Cephalometric data of 25 sets of parents having children with CL ± P were compared with that of 25 sets of parents of children without CL ± P. The study population was indigenous to North Karnataka. In all, 10 linear, 2 angular, and 5 triangular measurements were made on lateral cephalograms and compared using an unpaired t­test. RESULTS: The length of the posterior cranial base (S-Ba) in mothers was smaller in the study compared to the control group. Total facial height (N-Me) both in fathers and in the group with both parents, upper facial height in the group with both parents, and lower facial height (ANS-Me) in fathers was smaller in the study than in the control group. The area of the nasopharyngeal triangle (S-PNS-Ba) in mothers and that of the anterior maxillary triangle (S-N-A) in fathers was smaller in the study group than in the control group. CONCLUSION: Parents of children with CL ± P showed variations in craniofacial morphology. Future research correlating cephalometric findings with genetic studies may indicate whether cephalometric analysis can be an adjunct to genetic tests for risk prediction among susceptible parents.

Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique.

Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

Classification and surgical management of temporomandibular joint ankylosis: a review.

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.