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1.
Plast Reconstr Surg ; 2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32590515

RESUMEN

BACKGROUND: Facial asymmetry due to unilateral condylar hyperplasia (UCH) requires treatment to address facial and occlusal imbalances. There is no definitive evidence to suggest that a single intervention strategy (during either active condylar overgrowth or the burnt-out phase) results in better / more symmetric correction. This study sought to quantify pre- and post-operative facial asymmetry in UCH patients comparing treatment for active versus burnt out disease. METHODS: Pre- and post-operative three-dimensional (3D) photographs were obtained. Images were compared to unaffected controls as a standard for normal facial symmetry. Facial asymmetry was assessed using root mean squared deviation (RMSD). Paired student's t-tests were performed to compare the RMSDs of pre- and post-operative images between the UCH groups and against controls. RESULTS: Forty patients were included (11 active, 9 burnt-out, and 20 controls) and 60 3D images were evaluated. Pre-operatively, patients in the burnt-out group had worse asymmetry than those with active UCH (p = 0.011). Both groups demonstrated significantly improved symmetry post-operatively (active; p = 0.0069 and burnt out; p = 1.74E-4). However, burnt out patients remained with some residual asymmetry (p = 4.75E-4), while their active counterparts showed no significant difference compared to unaffected controls (p = 0.089). CONCLUSION: Patients with end-stage UCH have more severe facial asymmetry that is more difficult to normalize, compared to earlier intervention during active UCH. These findings suggest that, if possible, corrective intervention is preferable during active UCH.

2.
Oral Maxillofac Surg Clin North Am ; 32(2): 297-307, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32151372

RESUMEN

Orthodontic treatment of patients with unilateral and bilateral cleft palate requires an extensive interdisciplinary approach to achieve optimal functional and esthetic rehabilitation. Intervention is divided into 3 main stages: early mixed, late mixed, and permanent dentition. Treatment modalities can vary according to developmental stage, severity of cleft, and presence of other dentofacial abnormalities. This article describes the use and efficacy of different orthodontic, orthopedic, and surgical approaches at each developmental stage of unilateral and bilateral clefts, whereby the orthodontist plays a pivotal role in the different phases of growth and development of the cleft lip and the patient.

3.
J Craniofac Surg ; 30(8): 2601-2603, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449227

RESUMEN

Correction of facial asymmetry caused by active unilateral condylar hyperplasia (CH) requires proper diagnosis, arrested ongoing condylar growth, and ultimately orthognathic surgery. Traditionally, prior to performing orthognathic surgery, active CH is addressed either by: awaiting natural cessation of condylar overgrowth, or performing an interval high condylectomy (to stop growth). However, these strategies both add to the total treatment time, by either waiting and confirming no active growth, or performing a first stage growth-arresting procedure. In this report, the authors describe concurrent high condylectomy, and 3-jaw orthognathic surgery, to address the root of the problem and provide aesthetic correction in the same setting. This clinical series illustrates a detailed description of this approach, highlighting operative order, and an analysis of outcomes.


Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Femenino , Humanos , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto Joven
4.
Cell Rep ; 28(3): 759-772.e10, 2019 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-31315053

RESUMEN

Mechanisms coordinating pancreatic ß cell metabolism with insulin secretion are essential for glucose homeostasis. One key mechanism of ß cell nutrient sensing uses the mitochondrial GTP (mtGTP) cycle. In this cycle, mtGTP synthesized by succinyl-CoA synthetase (SCS) is hydrolyzed via mitochondrial PEPCK (PEPCK-M) to make phosphoenolpyruvate, a high-energy metabolite that integrates TCA cycling and anaplerosis with glucose-stimulated insulin secretion (GSIS). Several strategies, including xenotopic overexpression of yeast mitochondrial GTP/GDP exchanger (GGC1) and human ATP and GTP-specific SCS isoforms, demonstrated the importance of the mtGTP cycle. These studies confirmed that mtGTP triggers and amplifies normal GSIS and rescues defects in GSIS both in vitro and in vivo. Increased mtGTP synthesis enhanced calcium oscillations during GSIS. mtGTP also augmented mitochondrial mass, increased insulin granule number, and membrane proximity without triggering de-differentiation or metabolic fragility. These data highlight the importance of the mtGTP signal in nutrient sensing, insulin secretion, mitochondrial maintenance, and ß cell health.

5.
J Craniofac Surg ; 28(5): 1369-1374, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28582287

RESUMEN

PURPOSE: Wider cleft palates are thought to be associated with increased complications and poorer outcomes following cleft palate repair. Objective cleft palate photographic measurement and assessment of complications have not been previously performed. The purpose of this study is to quantitatively characterize a series of cleft palate dimensions and to investigate possible correlations with Veau classification and intra-, peri-, and postoperative outcomes. METHODS: The analytic sample included primary cleft palate repairs performed by the senior author over a 2-year period. Standard photographs of clefts taken at the time of repair were analyzed using Image-J software. Demographic, intraoperative, perioperative, and postoperative information were collected. Width measurements were correlated with Veau classification, intraoperative variables, perioperative variables, and adverse outcomes. Statistical tests performed included simple regression analyses and multiple regression analysis. RESULTS: Out of 70 patients, 50 had adequate photographic documentation for inclusion in the study; 44% of patients were classified as Veau I with an average cleft width of 5.4 mm, 28% Veau II with an average of 8.9 mm, 16% Veau III with an average of 11.3 mm, and 12% Veau IV with an average of 10.0 mm. No patients exhibited postoperative bleeding, dehiscence, airway problems, infection, fistula formation, or return to the operating room. The authors found that increasing cleft width significantly predicts increasing Veau classification (P < 0.01), increasing operating time (P < 0.05), increased hypernasality (P < 0.05), and speech delay (P < 0.001). Additionally, the presence of an intentional alveolar fistula (Veau III or Veau IV clefts) significantly predicts fluid emission (P < 0.001) but cleft width did not predict fluid emission. Increased cleft width did not significantly predict length of stay. CONCLUSION: Our data demonstrate that wider preoperative cleft palates correlate with Veau classification, increased operating time, and slightly worsened postoperative sequela. There were no perioperative instances of bleeding, dehiscence, respiratory complications, infection, fistula formation, and return to operating room. Hypernasality and speech delay were associated with increased cleft palate width. Length of stay did not correlate with cleft palate width.


Asunto(s)
Fisura del Paladar/patología , Fisura del Paladar/cirugía , Fisura del Paladar/clasificación , Femenino , Humanos , Lactante , Masculino , Análisis Multivariante , Tempo Operativo , Complicaciones Posoperatorias , Estudios Retrospectivos , Habla , Resultado del Tratamiento
6.
J Oral Maxillofac Surg ; 75(1): 197-206, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27649463

RESUMEN

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.


Asunto(s)
Mandíbula/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cirugía Asistida por Computador/métodos , Articulación Temporomandibular/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Diseño Asistido por Computadora , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
J Craniofac Surg ; 25(5): 1829-32, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25203579

RESUMEN

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.


Asunto(s)
Tejido Adiposo/trasplante , Enoftalmia/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
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