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1.
Plast Reconstr Surg ; 145(5): 1262-1265, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32332550

RESUMEN

The Le Fort I osteotomy is a versatile operation for correction of developmental, congenital, and posttraumatic deformities of the lower midface. One of the challenges of the osteotomy is pterygomaxillary separation, with the potential for unfavorable fractures to the orbit/skull base or vascular injury. A modified technique for pterygomaxillary disjunction is the transmucosal tuberosity osteotomy. The authors have used this technique for pterygomaxillary separation in 200 consecutive Le Fort I osteotomies over a 3-year period (2014 to 2017). There were no episodes of unfavorable propagation to the skull base or orbit, oroantral or oronasal fistulae, excessive bleeding/vessel injuries, or vascular insufficiency to the maxilla. The transmucosal tuberosity approach is a reliable and safe method of performing the pterygomaxillary separation during the Le Fort I osteotomy.


Asunto(s)
Maxilar/anomalías , Osteotomía Le Fort/métodos , Humanos , Maxilar/cirugía , Osteotomía Le Fort/efectos adversos , Osteotomía Le Fort/instrumentación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología
3.
J Craniomaxillofac Surg ; 47(12): 1868-1874, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31812310

RESUMEN

BACKGROUND: Maxillary advancement may affect speech in cleft patients. AIMS: To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients. METHODS: Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability. RESULTS: The mean advancement of A point was 4.0 mm horizontally (range: -2.8-11.3) and 3.9 mm vertically (range -14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy. CONCLUSIONS: The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Osteotomía Maxilar/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteotomía Le Fort/métodos , Habla/fisiología , Insuficiencia Velofaríngea/fisiopatología , Adolescente , Adulto , Cefalometría/métodos , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Femenino , Finlandia , Humanos , Masculino , Avance Mandibular/métodos , Maxilar/anomalías , Maxilar/cirugía , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Trastornos del Habla/fisiopatología , Trastornos del Habla/cirugía , Resultado del Tratamiento , Insuficiencia Velofaríngea/cirugía , Adulto Joven
4.
J Craniomaxillofac Surg ; 47(12): 1881-1886, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31812313

RESUMEN

In synchronous primary premaxillary setback and cleft lip repair for bilateral cases with severely protruding premaxilla, stabilization of the premaxilla is mostly achieved by gingivoperiosteoplasty. This kind of repair carries risk of impairment of blood supply to the premaxilla and/or prolabium, and at the same time it cannot ensure adequate stabilization of the premaxilla postoperatively. To overcome these problems, we have developed a unique technique of fixation of the premaxilla. In this paper, we discussing this technique, its advantages, and potential complications associated with it. From 2016, 10 patients aged 4-10 months, with bilateral cleft lip and palate with premaxillary protrusion (≥10 mm) underwent premaxillary setback and cheilorhinoplasty in the same stage. Instead of gingivoperiosteoplasty, a 'lag screw' fixation technique was used to stabilize the premaxilla. The follow-up period ranged between 5 and 32 months. In all the cases, we achieved adequate stabilization of the premaxilla. None of the patients had any issue related to the vascularity of the premaxilla or prolabium. There was no impairment in the eruption process of deciduous teeth in the premaxillary segment. Overall aesthetic outcomes of the lip and nose were acceptable. This technique of premaxillary fixation with lag screw gives us the liberty to perform primary cheilorhinoplasty along with premaxillary setback in the same stage, without risking the vascularity of premaxilla and prolabium. It ensures adequate stabilization of the premaxilla, but evaluation of regular growth of the midface and, if needed, corrective orthodontic and surgical treatment in the follow-up periods are advisable.


Asunto(s)
Tornillos Óseos , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/anomalías , Maxilar/cirugía , Osteotomía Maxilar/métodos , Vómer/cirugía , Estética Dental , Femenino , Humanos , Lactante , Masculino , Procedimientos Ortopédicos/métodos , Resultado del Tratamiento
5.
J Craniomaxillofac Surg ; 47(11): 1690-1698, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31677987

RESUMEN

The aim of this study was to review the effects of early and late hard palate repair on maxillary growth. PubMed, Scopus, Web of Science, LILACS, Cochrane Library CENTRAL databases, OpenGrey, Google Scholar, and Clinical Trials were searched using a PICO strategy, with terms related to unilateral cleft lip and palate (UCLP) and timing of repair. Methodological quality evaluation was carried out using the Fowkes and Fulton guidelines, and quality (or certainty) of evidence and strength of recommendations were evaluated using GRADE (grading of recommendations, assessment, development and evaluation). Five retrospective and non-randomized studies were included in the study. Folkes and Fulton assessment showed a high risk of bias in all articles and very low levels of certainty (GRADE). The results showed conflicting findings for comparisons of the effects of timing of repair of hard palate in UCLP. Two studies presented better maxillary growth in a group operated on later (18 months after birth), two presented no differences between the results, and another presented better results in the group operated on earlier than 18 months of age. At this point, it cannot be proven or refuted that postponing hard palate surgery brings benefits for maxillary growth. Studies included in this review did not show similar conclusions. Randomized clinical trials present some ethical issues that make them difficult to perform.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/anomalías , Maxilar/cirugía , Humanos , Labio , Estudios Retrospectivos
6.
Am J Orthod Dentofacial Orthop ; 156(2): 266-274, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375237

RESUMEN

Adult orthodontic treatment involving maxillary transverse deficiency is a challenge for an interdisciplinary team. Surgically assisted rapid palatal expansion to segment the maxilla was once the treatment of choice, but the invasiveness, bone deficiency, and gingival recession hindered its acceptance. Corticotomy-assisted rapid maxillary arch expansion with ridge augmentation has the advantage of augmenting alveolar bony housing to accommodate and facilitate tooth movement. This approach was used to correct a severely constricted maxilla with bilateral posterior crossbite and anterior crowding in a 46-year-old man. Treatment time was 14 months. The accelerated arch expansion overcame the crossbite in 7 months, increasing intercanine distance by 5.2 mm and intermolar distance by 9.8 mm. Subsequent implant prosthesis was able to be restored in a functional normal occlusion. Satisfactory and stable clinical outcome was followed for 7 years. Corticotomy-assisted rapid maxillary arch expansion with alveolar bone augmentation is a novel and effective interdisciplinary approach for correcting adult maxillary transverse deficiency. Well controlled prospective clinical trails are warranted for further investigation.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Maloclusión/terapia , Técnica de Expansión Palatina , Técnicas de Movimiento Dental/métodos , Cefalometría , Modelos Dentales , Oclusión Dental , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/patología , Maloclusión/cirugía , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/patología , Maloclusión de Angle Clase II/cirugía , Maloclusión de Angle Clase II/terapia , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/patología , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Maxilar/anomalías , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Aparatos Ortodóncicos , Soportes Ortodóncicos , Alambres para Ortodoncia , Paladar (Hueso)/cirugía , Planificación de Atención al Paciente , Estudios Prospectivos , Resultado del Tratamiento
7.
Eur. j. anat ; 23(4): 273-277, jul. 2019. graf, tab
Artículo en Inglés | IBECS | ID: ibc-183001

RESUMEN

A thorough knowledge of external dental root morphology is fundamental for having successful endodontic, orthodontic and surgical treatments in dentistry. The aim of this anatomical study was to determine the incidence of tooth dilacerations in Kerman, a province in the Southeastern Islamic Republic of Iran. A cross-sectional study was performed on a total of 3150 teeth from 800 PA radiographs; 100 radiographs from each 8 anatomic divisions of the dental arch, within a Kerman population. The numbers of radiographs were equal between 2 genders; 400 from females and 400 from males. Radiographs were studied by 3 specialists in this field in order to determine and record the prevalence and distribution of dilacerations in different teeth of this population. Amongst the total of 3150 teeth from 800 radiographs, 52 teeth (1.65%) showed dilacerations. The prevalence of this anomaly was 7.5% in males and 5% in females, and the distribution was almost equal between different teeth of the maxilla (2%-4%); meanwhile in the mandible, the maximum prevalence was in third molars (14%) and the rate was nil in anterior teeth (Spss and Excel softwares, IBM). The prevalence of tooth dilacerations was almost equal between genders in the Kerman population that was studied. The findings indicated that the presence of dilacerated roots was more prevalent in females in the mandibular arch, while this anomaly was more prevalent in males in the maxillary arch. Interestingly, none of the mandibular incisor teeth displayed this anomaly


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Dentición Permanente , Arco Dental/anatomía & histología , Arco Dental/anomalías , Mandíbula/anatomía & histología , Maxilar/anomalías , Irán , Arco Dental/diagnóstico por imagen
8.
J Craniofac Surg ; 30(4): 1149-1153, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31166261

RESUMEN

OBJECTIVE: The aim of this study is to describe the importance of osteodistraction with transpalatal distractors for treating transversal maxillary hypoplasia in patients with cleft and lip palate. METHODS: The participants were 17 patients (9 females and 8 males) with cleft lip and palate. Among these, 10 presented unilateral cleft lip and palate, 4 bilateral cleft lip and palate, and 3 cleft palate only. RESULTS: All patients experienced a satisfactory palatal expansion and crossbite correction. The mean lengthening was 12.7 mm. The average increase of intercanine distance, intermolar distance, maxillary transverse dimension (MTD), facial transverse dimension (FTD) was 12.16, 8.45, 1.77, and 1.67 mm, respectively. The clinical follow-up was 29.7 months (range: 6-61 months). CONCLUSION: Palatal distraction is a safe and successful alternative for treating maxillary transversal alterations in patients with cleft lip and palate. This technique facilitates the establishment of an adequate transverse dimension of maxillary, and consequently a proper dental occlusion.


Asunto(s)
Labio Leporino/terapia , Fisura del Paladar/terapia , Técnica de Expansión Palatina , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Maloclusión/terapia , Maxilar/anomalías
9.
Curr Opin Otolaryngol Head Neck Surg ; 27(4): 302-309, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31219831

RESUMEN

PURPOSE OF REVIEW: To discuss multidisciplinary treatment options for the protuberant premaxilla associated with bilateral cleft lip and palate. Lessons have been learned throughout the years regarding the effect of growth restriction after early and aggressive therapy. Multiple surgical and orthodontic interventions are discussed. Recent literature will be highlighted and discussed. RECENT FINDINGS: A paucity of long-term studies was noted. Recent literature revealed numerous studies introducing innovative presurgical orthopedic devices as less expensive and easier to use alternatives to nasoalveolar molding. Multiple approaches to premaxillary setback were presented, offering multiple approaches to improve success rates and minimize burden to the patient. Novel orthodontic and advanced microvascular procedures were discussed as additional tools for treatment of the malpositioned premaxilla once skeletal maturity is reached. SUMMARY: Multidisciplinary team management of the protuberant premaxilla and bilateral cleft lip and palate is becoming increasingly embraced worldwide. Numerous surgical procedures and orthodontic treatments are required to optimally reposition the premaxilla; however, these interventions can inhibit growth, resulting in maxillary retrusion. Long-term follow-up studies are needed to determine what protocol is best. Studies should also include ways to overcome barriers to treatment success, such as late intervention, resource disparity, and limited access to care.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/anomalías , Maxilar/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Humanos , Microcirugia/métodos , Procedimientos Ortopédicos/métodos
10.
Clin Ter ; 170(3): e168-e173, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31173044

RESUMEN

OBJECTIVES: To show the orthodontic treatment in a 8-year-old patient affected by Ectodermal Dysplasia (hypohidrotic type) and presenting multiple agenesiae, contraction of the maxilla and skeletal Class III malocclusion. STUDY DESIGN: Because of both oligodontia of primary and secondary dentition and no good retention and anchoring, a hybrid modified rapid palatal expander (RPE) was used. It presented dental anchoring with two bands on first upper molars and skeletal anchoring with two miniscrews in the anterior palate. The project included the use of a CBTC for the bone examination and precise silicon dental impression for the insertion of miniscrews. RESULTS: The procedure was successful and the patient solved the expansion in few days, so RPE has been embedded throughout 6 months in order to develop the bone at the median suture. CONCLUSIONS: This case report can be considered as a valid example for approaching patients affected by Ectodermal Dysplasia with multiple agenesiae and palatal contraction because of the difficult retention.


Asunto(s)
Displasia Ectodérmica/terapia , Maloclusión de Angle Clase III/terapia , Técnica de Expansión Palatina , Niño , Humanos , Masculino , Maxilar/anomalías , Métodos de Anclaje en Ortodoncia/métodos , Diseño de Aparato Ortodóncico , Paladar (Hueso)/anomalías
11.
Prenat Diagn ; 39(6): 415-419, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30900264

RESUMEN

Solitary median maxillary central incisor (SMMCI) syndrome is a complex disorder consisting of multiple, developmental defects involving midline structures of the head, which includes the cranial bones, the maxilla, and its container dentition (specifically the central incisor tooth germ), together with other midline structures of the body. SMMCI may appear as an isolated trait or in association with other midline developmental anomalies. We describe the case of a patient with SMMCI. He presented with a solitary median maxillary incisor, short stature, corpus callosum anomalies and a microform of holoprosencephaly (HPE), diabetes insipidus, and neurodevelopmental delay. The diagnosis was performed postnatally based on clinical features, radiological imaging, and a comprehensive genetic study. SMMCI can be diagnosed during the prenatal or neonatal periods or during infancy. Evaluation of the superior maxillary bone is important for prenatal diagnosis. Direct evaluation through bidimensional ultrasound or the use of multiplanar ultrasound or tridimensional reconstruction should be performed in cases of brain or face malformations. Early diagnosis can contribute to improved prenatal assessment and postnatal management.


Asunto(s)
Anomalías Múltiples/diagnóstico , Anodoncia/diagnóstico , Incisivo/anomalías , Diagnóstico Prenatal , Anomalías Múltiples/patología , Anodoncia/complicaciones , Anodoncia/patología , Femenino , Holoprosencefalia/complicaciones , Holoprosencefalia/diagnóstico , Holoprosencefalia/patología , Humanos , Incisivo/patología , Lactante , Recién Nacido , Masculino , Maxilar/anomalías , Fenotipo , Embarazo , Pronóstico , Síndrome , Adulto Joven
12.
Clin Plast Surg ; 46(2): 157-171, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30851748

RESUMEN

Cleft orthognathic surgery is an important component of a comprehensive cleft care plan. Applying combined orthodontic and orthognathic treatment principles to a cohort of patients with cleft lip and palate raises many challenges not encountered in conventional orthognathic care. Cleft patients share a commonality in their midfacial anatomy that is characterized by a 3-dimensionally deficient maxilla. The residual sequelae of multiple previous surgeries along with dental differences and unhealed fistulae are considerations when embarking on treatment. This article describes many of these challenges and highlights approaches that are used to address the specific needs of this special group of patients.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteogénesis por Distracción/métodos , Injerto de Hueso Alveolar , Femenino , Humanos , Masculino , Maxilar/anomalías , Procedimientos Quirúrgicos Orales/métodos , Soportes Ortodóncicos , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Osteotomía Le Fort , Cuidados Posoperatorios , Complicaciones Posoperatorias
13.
J Plast Surg Hand Surg ; 53(3): 130-137, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30782083

RESUMEN

The dysplastic maxilla and retracted zygoma characterize Apert's syndrome. The relationship between the cranial base and facial development is believed to be influential and substantial. The purpose of this study is to explore the temporal relationships of maldevelopment of these structures to identify potential influence patterns. Fifty-four CT scans (unoperated Apert's, n = 18; control, n = 36) were included and divided into three age subgroups (0-6 months, 6 months-2 years, and 2-6 years). All measurements were analyzed by Materialize software. Cephalometrics relating to midface and cranial base were collected. In anteroposterior direction, prior to 6 months, the zygoma was markedly retruded by 12% in Apert's, followed by persistent retrusive shape into adulthood, averaging 17% shorter compared to controls. The maxillary anteroposterior dimension was 22% shorter than normal before 6 months of age, thereafter, it maintained at least an 18% deficiency into adulthood. In the horizontal direction, the transverse width of the zygoma increased 39% between 6 months and 2 years of age, and it was 14% wider on average overall into adulthood. The maxilla had normal growth in transverse and vertical directions. The zygoma is the most severely deformed anatomic facial structure in early infancy, in both positional relation and geometric shape in Apert's syndrome. This may develop as a 'bridge', influencing the structure, transmitting malformation stresses, caused by premature fused coronal and peri-zygomatic sutures, into facial structures and the maxilla.


Asunto(s)
Acrocefalosindactilia/complicaciones , Maxilar , Cigoma , Adolescente , Estudios de Casos y Controles , Cefalometría , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Maxilar/anomalías , Maxilar/diagnóstico por imagen , Nariz/anomalías , Nariz/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven , Cigoma/anomalías , Cigoma/diagnóstico por imagen
14.
J Indian Soc Pedod Prev Dent ; 37(1): 107-109, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30804316

RESUMEN

Teeth which erupt in the 1st month of postnatal life are known as "neonatal tooth." The incidence of these teeth ranges from 1:2000 to 1:3500 live births. Natal teeth are more common in mandibular central incisor region, followed by maxillary incisor region and mandibular canine region. The neonatal or natal teeth in the maxillary molar region are a rare occurrence. This article represents a rare case of the neonatal tooth with Langerhans cell histiocytosis.


Asunto(s)
Histiocitosis de Células de Langerhans/patología , Diente Molar/anomalías , Erupción Dental , Humanos , Lactante , Masculino , Maxilar/anomalías , Diente Molar/crecimiento & desarrollo , Diente Molar/patología
15.
J Craniomaxillofac Surg ; 47(3): 420-430, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30642732

RESUMEN

INTRODUCTION: Le Fort III distraction osteogenesis with a rigid external distraction device is a powerful procedure to correct both exorbitism and impaired airways in faciocraniosynostosis. The aim of this study was to investigate treatment effect, perioperative parameters and volumetric outcomes after Le Fort III distraction osteogenesis in patients with Crouzon syndrome in a retrospective study design and to explore potential strengths and weaknesses of this procedure. MATERIALS AND METHODS: From June 2013 to February 2015, a total of nine children with Crouzon syndrome underwent Le Fort III distraction osteogenesis with a rigid external distraction device (RED device, KLS Martin, Tuttlingen, Germany). Along with perioperative parameters, sleep study reports, traditional cephalometric analysis, three-dimensional imaging and photographs were evaluated for severity of disease and therapeutic effect and structural and functional changes of the upper airway preoperatively, after device removal and one year postoperatively. RESULTS: Surgery for Le Fort III distraction was performed at a median age of 12.5 years (SD 2.5 months) with an average weight of 43.0 kg (SD 12.9 kg). Mean estimated blood loss was 535.7 ml (SD 128.1 ml), not requiring any red blood cell transfusions. Mean duration of surgery was 240 min (SD 30.6min), average hospital stay eight days (SD 0.5 days) with a planned median ICU stay of 1.7 days (SD 0.4 days) for all patients. There were a total of five minor complications. Exorbitism and Angle class III malocclusions were corrected in all patients. No patient showed velopharyngeal problems postoperatively. The average amount of distraction was 18.4 mm (14-26 mm). Average length of the distraction period was 18.3 days (SD 0.4 days), with a total distraction plus consolidation time of three months (SD 0.25 months). In two patients, vector correction was performed during distraction. A counterclockwise movement despite vector correction, clinically resulting in an open bite, was observed in one of these two patients. Eight of the nine patients showed a frontal overbite at the end of the distraction period. Cephalometric analysis revealed a significant increase of Sella-Nasion-Point A angle (SNA) from 76.0° (+/- 2.9; T1) to 86.0° (+/- 3.4; T2) (p = 0.006) and growth-related point A-Nasion-point B angle (ANB) from -4.8° (+/-3.7) to 5.7° (+/-4.8) (p = 0.001) from preoperatively to device removal and stable results one year postoperatively. Upper airway structure and respiratory function were improved clinically after the Le Fort III DO treatment in all cases with an average posterior airway space increase from 3199 mm3 (+/- 229.6 mm3) to 8917,7 ml (+/-415.1 mm3) (T1 to T2). Surgical outcome was judged good to excellent both by patients and families and the craniofacial team. CONCLUSION: Le Fort III DO with a rigid external distraction device in patients with Crouzon syndrome is a powerful and reliable surgical procedure that reliably produces a more significant change of appearance than most other single procedures routinely performed by craniofacial surgeons. It effectively treated sleep apnea in the affected patients. In our collective, the maxilla remained stable after advancement without any relapse, but there was no subsequent anterior growth on one year follow-up. Careful vector planning was able to avoid frontal open bite in eight patients. Complication rates were acceptably low and patients' functional and esthetic outcome was high.


Asunto(s)
Disostosis Craneofacial/cirugía , Maxilar/cirugía , Osteogénesis por Distracción/métodos , Osteotomía Le Fort/métodos , Adolescente , Cefalometría , Niño , Disostosis Craneofacial/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional , Masculino , Maxilar/anomalías , Osteogénesis por Distracción/instrumentación , Estudios Retrospectivos
16.
Cranio ; 37(2): 136-139, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29448905

RESUMEN

BACKGROUND: A sleep study of a 56-year old male with excessive daytime sleepiness demonstrated an AHI of 16.4hr-1 with 13% of total sleep time in REM sleep and a mean oxygen desaturation (SpO2) of 86%. CLINICAL PRESENTATION: On intra-oral examination, it was found that the patient had maxillary hypoplasia and bilateral torus mandibularis. A 3D cone-beam CT (CBCT) scan was taken, and 28 craniofacial parameters were measured. Surgical reduction of the mandibular tori followed by biomimetic oral appliance therapy (BOAT) was initiated. After 14 months, a post-treatment CBCT scan revealed that 70% of parameters measured had improved. Therefore, another sleep study was performed with no device in the mouth. This follow-up home sleep test demonstrated that the AHI fell to 5.3hr-1hr; with 27% REM sleep, and a mean SpO2 of 93% without any device in the mouth. CONCLUSION: These findings suggest that BOAT might be able to restore sleep in certain adult cases.


Asunto(s)
Anomalías Craneofaciales/complicaciones , Anomalías Craneofaciales/cirugía , Mandíbula/anomalías , Mandíbula/cirugía , Maxilar/anomalías , Procedimientos Quirúrgicos Orales , Aparatos Ortodóncicos Funcionales , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/rehabilitación , Sueño , Tomografía Computarizada de Haz Cónico , Anomalías Craneofaciales/diagnóstico por imagen , Anomalías Craneofaciales/terapia , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Masculino , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Oximetría , Apnea Obstructiva del Sueño/diagnóstico por imagen , Apnea Obstructiva del Sueño/cirugía , Sueño REM , Resultado del Tratamiento
18.
J Craniofac Surg ; 30(1): e60-e62, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30480632

RESUMEN

To reduce the deviations in the horizontal direction of posterior maxilla during the maxilla Le Fort I osteotomy, the authors develop and validate the precise midline positioning instrument for Le Fort I osteotomy, which can guide the precise relocation of the truncated maxillary bone segment. The patent application for the precise midline positioning instrument for Le Fort I osteotomy is already submitted (patent no: 201711245533.6, China). The accuracy of Le Fort I osteotomy can be improved significantly, because of the amplification effect of this patent on the rotation/micro-movement of the posterior maxilla in all directions to achieve the precise movement and pairing of the maxillary bone segment. And this method is simple, efficient, and laborsaving.


Asunto(s)
Maxilar/cirugía , Osteotomía Le Fort/instrumentación , Femenino , Humanos , Masculino , Maxilar/anomalías
19.
Int J Oral Maxillofac Surg ; 48(3): 309-321, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30389113

RESUMEN

The facial malformations of Crouzon syndrome involve the entire cranio-orbito-zygomatic region. The detailed sequence of changes in orbit, zygoma, and maxilla over time, the mutual influence among these three anatomical structures, and their relationship with the cranial base were studied to determine the sequence and timing of deformity. Preoperative CT scans of 36 patients with Crouzon syndrome (mean age 10.84±14.70years; 14 male, 22 female) and CT scans of 54 control subjects (mean age 8.53±13.22years; 29 male, 25 female) were divided into five subgroups by age: 0-6 months, 6 months-2 years, 2-6 years, 6-18 years, and 18-62 years. Craniofacial morphometric cephalometrics were analyzed using Materialise software. Crouzon orbit anteroposterior length was shorter before 6 months (P=0.021) and remained shorter into adulthood (P<0.001). Globe projection was greater across all age subgroups (P<0.001), reaching a peak at 6 months to 2 years (P<0.001). The increased medial orbital width was the most remarkable and persistent secondary deformity (P<0.001). The zygoma anterior protrusion was retruded before 6 months of age (P<0.001), but then improved gradually. The width of maxilla was greater by 24% in the Crouzon cohort (P<0.001), with a difference of 16% before 6 months (P=0.024), and was developed earlier than the shortened anteroposterior length. Crouzon high and shallow orbital walls are distinctive. Maxillary widening developed before the malformation of sphenoid. The anteroposterior position of zygoma is likely a principal deformity, rather than a reflection of the intrinsic shape of the bone. Level of Evidence: II.


Asunto(s)
Disostosis Craneofacial/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Órbita/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Cigoma/diagnóstico por imagen , Adolescente , Adulto , Antropometría , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Maxilar/anomalías , Persona de Mediana Edad , Órbita/anomalías , Cigoma/anomalías
20.
Congenit Anom (Kyoto) ; 59(1): 11-17, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29691907

RESUMEN

Turner syndrome is associated with an X chromosome abnormality in women and is characterized by infantilism, congenital webbed neck, and cubitus valgus. The aim of this study was to determine the maxillofacial morphology and oral characteristics of Japanese girls (mean age, 8.5 years) with Turner syndrome and early mixed dentition. Lateral cephalograms obtained at the first visit were used to analyze maxillofacial morphology. Oral characteristics were identified using orthopantomograms, intraoral photographs, and study casts. All patients received growth hormone. Lateral cephalograms showed a retrognathic maxilla and mandible and a small gonial angle. Nine patients had a high-arched palate. Nine patients had class II first molar relationship occlusion and one had mesial step-type occlusion. Three patients showed ectopic eruption of the maxillary first permanent molar accompanied by resorption of the maxillary second primary molar. Eruption of the permanent teeth tended to occur early. The median mesiodistal diameter of the maxillary central incisor was smaller than the Japanese norm. Ectopic eruption of the maxillary first permanent molar may be caused by lack of eruption space and a discrepancy between bone growth and timing of tooth maturation.


Asunto(s)
Arco Dental/patología , Cara/anomalías , Mandíbula/anomalías , Maxilar/anomalías , Síndrome de Turner/patología , Cefalometría , Niño , Arco Dental/diagnóstico por imagen , Dentición Mixta , Cara/diagnóstico por imagen , Femenino , Hormona del Crecimiento/uso terapéutico , Humanos , Incisivo/anomalías , Incisivo/diagnóstico por imagen , Cariotipo , Maloclusión/diagnóstico por imagen , Maloclusión/patología , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Diente Molar/anomalías , Diente Molar/diagnóstico por imagen , Radiografía Panorámica , Erupción Dental/fisiología , Síndrome de Turner/diagnóstico por imagen , Síndrome de Turner/tratamiento farmacológico , Síndrome de Turner/genética
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