The Median Mandibular Symphysis Tessier 30 Cleft:: 3D Imaging Analysis and Review of the Literature.

Atypical craniofacial clefts of the upper facial region have been well documented; however, the mandibular clefts remain rare and reported as isolated case reports. We report a case of a median mandibular cleft within the context of a Tessier 0-14 axis that we have followed over a 5-year period without surgical/orthodontic intervention. The mandibular symphysis cleft remained open without evidence of the fusion, in contrast to ossification of the metopic dysraphism. Within this context, we present a review of the median mandibular cleft cases from 1819 to 2015.

Hallazgos incidentales en ortopantomografías maxilomandibulares de pacientes adultos jóvenes / Incidental findings on panoramic radiographs of the maxilla and mandible of young adult patients

Introducción: la valoración radiográfica rutinaria en la práctica odontológicaes esencial para un adecuado diagnóstico y plan de tratamiento. Laortopantomografía o radiografía panorámica es una técnica simple, rápida, de bajo costo y a una baja dosis de radiación. Objetivos: Caracterizarlos hallazgos incidentales más comunes en radiografías panorámicas de pacientes adultos jóvenes de una clínica dental universitaria. Materialy métodos: Se realizó un estudio descriptivo, retrospectivo, de cortetransversal de radiografías panorámicas digitales, tomadas e interpretadas de manera ciega, explorando alteraciones óseas y anomalías dentales. Se realizó la caracterización de su presentación por género de los participantes. Para el análisis de datos se utilizaron pruebas no paramétricas (la prueba χ2, exacta de Fisher y binomial). Resultados: Se tomaron 98 radiografías del mismo número de pacientes, con edad promedio de 19.45 años, predominando las mujeres (69/70.40 por ciento), solteros (94/95.91 por ciento) y de zona urbana (77/78.57 por ciento). Existieron 387 alteraciones, 268 (69.25 por ciento) enmujeres, y 119 (30.74 por ciento) en hombres, con un promedio de 3.88 y 4.10 alteraciones por paciente, respectivamente. La distribución mostró en total 122 (31.52 por ciento) lesiones a nivel de senos maxilares, 124 (32.04 por ciento) en fosasnasales, 16 (4.13 por ciento) lesiones radiolúcidas u opacas, y 125 (32.29 por ciento) anomalías asociadas a retención dental. La comparación de acuerdo al género mostró diferencia (p ≤ 0.001) en la frecuencia de alteraciones, en todos los casos determinada por las mujeres, para cada sitio y tipo de lesión presentada. Conclusiones: El valor de la radiografía panorámica para detectar anomalías de estructuras orofaciales demostró en este estudio su utilidad en la práctica asistencial desde una perspectiva epidemiológica.

Background: doutine dental X-Ray assessment in dental practice isessential for proper diagnosis and treatment. Orthopantomographyor panoramic radiography is a quick, simple, low-cost, and low-doseradiation technique. Objective: To describe the most common incidentalfi ndings on the panoramic radiographs of young adult patients ata university dental clinic. Material and methods: A descriptive,retrospective, cross-sectional study was carried out, in which digitalpanoramic radiographs were taken and interpreted blindly to examinebone disorders, and dental anomalies, and the prevalence of theseaccording to the gender of the participants. Nonparametric statistics(Chi-square χ2, Fisher’s exact, and binomial tests) were used for dataanalysis. Results: 98 radiographs were taken of the same number ofpatients with a mean age of 19.45 years, most of whom were women(69/70.40%), single (94/95.91%), and from urban areas (77/78.57%). 387alterations were found, 268 (69.25%) in women and 119 (30.74%) in men,with an average of 3.88 and 4.10 alterations per patient, respectively. Thedistribution presented a total of 122 (31.52 %) lesions in the maxillarysinus, 124 (32.04 %) in the nostrils, 16 (4.13 %) radiolucent or opaquelesions, and 125 (32.29%) anomalies associated with tooth retention. Acomparison by sex revealed a diff erence (p < 0.001) in the frequency ofalterations, which was greater in women for all sites and types of lesion.Conclusions: The study showed the usefulness of panoramic radiographyin clinical practice to detect anomalies of the orofacial structure from anepidemiological perspective.

Phenotypic classification of variability of non-syndromic congenital cleft lip and jaw in Vorderwald × Montbéliarde cattle.

BACKGROUND: Non-syndromic congenital cleft lip and jaw (CLJ) is a condition reported in several cattle breeds, but a detailed classification system does not exist for cattle. The objective of the present study was to describe the phenotypic variability of this orofacial malformation in Vorderwald × Montbéliarde cattle. For this purpose, a classification system of CLJ was developed on examination of five orofacial structures: (1) lips, (2) the processus (proc.) nasalis of the os incisivum, (3) the dental plate with adjacent segments of the hard palate, (4) the facial bones (os incisivum, os maxillare, os nasale and os palatinum) and (5) the mandibles. Each structure was given a score reflecting the degree of the lesion from absent (score 0) to severe. RESULTS: Nine cases were included in the study and they shared absence of the abaxial rostral part of the processus (proc.) nasalis of the os incisivum, partial loss of the rugae palatinae and the dental plate. A sigmoid curvature of the rostral lower jaw as well as a lateral deviation of the face and rostral lower jaw was highly variable in their expression. These deformations were present in eight of nine cases. In addition to the complete CLJ, three animals had an incomplete CLJ on the contralateral site with variable defects of the rostral part of the proc. nasalis of the os incisivum. CONCLUSIONS: A complete CLJ is obviously accompanied by a loss of parts of the proc. nasalis of the os incisivum. Extent and localization of the missing parts of the proc. nasalis were similar in all cases. A precise classification of the various CLJ forms is necessary.

Congenital zygomatico-mandibular fusion (pseudo-syngnathia?) in conjunction with unilateral anophthalmia: review of terminology and classification.

Syngnathia per se is a rare congenital disorder. A literature survey reveals a total of 26 cases of syngnathia in the English literature since 1936, of which only seven cases involved fusion of the ascending ramus of the mandible to the posterior portion of the maxilla and zygomatic complex. The remaining 19 involved fusion of the alveolar ridges of the maxilla and mandible. This is a unique case of fusion of the mandible to the zygomatic complex presenting with a unilateral anophthalmic orbit in an 18-day-old neonate. The use of the term syngnathia has been reviewed and a modification in classification has been suggested.

Hipoplasia maxilar: experiencia clínica en criterios terapéuticos determinados por la maduración esqueletal / Maxillary hypoplasia: clinical experience in therapeutic criteria determined by the esqueletal maturation

El objetivo de esta experiencia clínica es presentar las estrategias de tratamiento de la hipoplasia maxilar determinadas por el grado de maduración esqueletal del paciente. Se presentan dos pacientes con hipoplasia maxilar e hiperplasia mandibular tratados en el Hospital Clínico Universidad de Chile (HCUCh). El primer caso es un paciente pediátrico en el cual se realizó tratamiento ortopédico y el segundo caso es un paciente con crecimiento óseo terminado, cuya resolución es a través de cirugía ortognática. El diagnóstico, seguimiento y medición de resultados se hizo evaluando parámetros clínicos y análisis cefalométricos teleradiográficos. Resultados: en ambos casos se logró una relación de tejidos blandos y esqueletales máxilomandibulares de acuerdo a la norma clínica y cefalométrica. La hipoplasia maxilar con un adecuado tratamiento logra una mejora estética satisfactoria. El diagnóstico en edades tempranas de la patología da ventajas en el tratamiento haciéndolo más fácil, corto, económico y no invasivo.

Conceptos generales sobre anomalías dentomaxilares / General concepts on dentomaxillary abnormalities

La gran mayoría de las anomalías dentomaxilares (ADM), son observadas primariamente por los pediatras, quienes siguen de cerca el cambio dentario. Sin embargo, ellos no siempre conocen el manejo de las ADM, o la forma en que se recomienda su tratamiento. Para entender cabalmente la etiología de las ADM, es necesario observar todo el entorno que rodea la misma, haciéndose útil muchas veces la interconsulta y/o derivación oportuna al odontopediatra, ortodoncista u otra especialidad médica. Dado el importante papel del pediatra en la familia, este artículo tiene el propósito de clarificar ciertos conceptos sobre anomalías dentomaxilares, facilitar el reconocimiento de ellas y permitir así la disminución de su prevalencia

Midface prognathism in maxillonasal dysplasia (Binder's syndrome) determined by a theoretical midface ratio.

A theoretical midface ratio was determined from midface lengths and heights in straight lateral radiographs. Using regression analyses, the ratio was tested on 90 adults who did not have an aberrant anatomy of the maxilla. A linear relationship was found between the theoretical midface ratio and sella-nasion-point A (SNA), and the correlation was high (adjusted R2 = 82.7%). Limit values were determined using the theoretical midface ratio for the classifications of retrognathia, orthognathia, and prognathia. Conditional probabilities were estimated for classifications according to SNA for every classification by the theoretical midface ratio. Eighty percent of the subjects were identically classified by SNA and the theoretical midface ratio, and no subjects were placed differently in the extreme groups of retrognathia and prognathia. The theoretical midface ratio was then used to estimate the degree of prognathism in 35 adults with maxillonasal dysplasia. Less than half of the subjects had maxillary retrognathia, and the majority had an orthognathic or even prognathic maxilla. This is an indication that individualization of treatment objectives, including the consideration of mandibular setback operations to correct incisor crossbites, is equally important in maxillonasal dysplasia and in normal anatomy.

Congenital oral synechiae.

Major congenital synechiae of the oral cavity constitute a clinically confusing spectrum of abnormalities. On the basis of clinical data, we propose two categories: 1) abnormalities secondary to persistence of the buccopharyngeal membrane and 2) abnormalities secondary to formation of ectopic membranes. An ectopic membrane results from abnormal fusion and can be subclassified as a subglossopalatal membrane, glossopalatal ankylosis, or syngnathia. This classification is supported by embryologic studies and is used to reclassify all cases reported since 1900. Distinct differences, such as the presence of associated limb anomalies, emerge; these are reviewed and add support to the proposed classification.

Descriptive terminology for jaw anomalies.

A descriptive terminology for jaw abnormalities was developed and has been used for many years. This terminology was based primarily on inspection of patients and evaluation of cephalometric x-ray images and defines the anatomic location of abnormalities. Its aids in communication between doctors of different specialties.

A validity test of cephalometric variables as a measure of clinical applicability in anteroposterior profile assessment.

Twenty-six profile silhouettes are divided by five judges into three categories: retrognathic, orthognathic, and prognathic. On the corresponding lateral cephalograms, 51 cephalometric variables are tested for profile recognition. Discriminant analysis indicates that measurements based on natural head position perform better than comparable variables based on an intracranial reference line. The soft tissue variables (SnPo'-SnTV, Po'-SnTV, ILS-SnTV) are most successful, but no single variable is totally accurate. Skeletal variables relating the maxilla to the mandible (APo, AB, NA-PoA) are more successful than those variables relating one arch to the remainder of the skull (A-FHP, B-NTV, SNA, SNB). A combination of soft tissue and dental variables (SnPo'-SnTV, SnPo'-TMe', 1u-Npo, 1l-NPo) is found to be completely successful. A methodological approach, as applied in this study, can pinpoint the cephalometric variables that are clinically more effective in describing certain facial features.

[The classification of anomalies of the maxillodental system]. / Klassifikatsiia anomalii zubocheliustnoi sistemy.

Since the known classifications of maxillodental abnormalities are either not up-to-date or essentially differ from the WHO classification, the authors suggest a working scheme for classification of maxillodental abnormalities, that is based on the international classification of diseases. All the principal disorders of the maxillodental system structure are taken into consideration in the suggested scheme, that is, in fact, a clinico-morphologic and therefore pathogenetic classification.

Orthodontic considerations applied to craniofacial dysmorphology.

The contemporary management of patients with craniofacial anomalies involves a team approach of multiple specialists. Interaction between the basic scientist, developmental biologist, and the clinician should be an important aspect of interdisciplinary research if clinically relevant questions are to be addressed under rigorous laboratory conditions. The clinical investigator may be unfamiliar with the terminology and methodology of basic biomedical research. As a result, there can be a lack of communication between the clinician and the basic scientist. The role of the orthodontist in a multidisciplinary craniofacial team has evolved largely from an interest in dysmorphology as applied to craniofacial growth and development. The predictability of orthognathic surgery has been derived from the close collaboration between the orthodontist and surgeon and may be applied to the more comprehensive management of patients with craniofacial anomalies. To determine the mechanisms underlying the pathogenesis and response to treatment will require a collaborative approach by the clinician and research scientist to elucidate causal and putative risk factors in the complex genetic and environmental associations involved in craniofacial anomalies.