Development prediction of sagittal itermaxillary relations in patients with complete unilateral cleft lip and palate during puberty.

The main objective was to find a predictive model for the development of the jaw in patients with the most frequent facial cleft malformation, i.e. complete unilateral cleft lip and palate (UCLPc) by means of multivariate methods. This prediction is urgently needed from the clinical aspect. It will make it possible to provide early detection for patients at risk of adverse development. The study is based on a long-term X-ray cephalometric follow-up of 73 boys with UCLPc during puberty. Prediction was performed by methods of multiple regression and regression partitioning trees. The best equation predicts the intermaxillary relations at 15 years of age with high reliability (determination coefficient R2 = 0.822). The model was successfully verified statistically. In clinical practice, we suggest the use of a simple method of regression partitioning trees where the measurement of only 1 to 4 dimensions in a ten-year-old patient would suffice to achieve a reliable reading of the ANB angle at 15 years of age from a tree diagram.

Denture reconstruction of the edentulous upper jaw in cleft palate using implants--clinical report.

OBJECTIVE: Early prosthodontic therapy (usually at around 18 years of age) often leads to early loss of teeth and in extreme cases to complete loss of dentition at between 40 and 50 years of age. PATIENTS: This report describes the clinical features of two middle-aged cleft patients. Edentulous maxilla with cleft defect was treated with 6 implants supported by fixed appliance. RESULTS: Treatment of the whole dental arch on the basis of implants is currently frequently used as it provides a possibility of thorough functional and aesthetic therapy to a patient. The biomechanics of the reconstruction enables individual adjustment of the shape of the dental arch. CONCLUSIONS: The problem in cleft patients involves other diameter relations in the dental arch caused by the defect alone or also by affecting the growth of the maxillary segment by surgery. A potentially removable framework is therefore the main method of choice because the position of the implants must be prosthetically modified.

Analysis of facial skeleton shape in patients with complete unilateral cleft lip and palate: geometric morphometry.

The study is based on a longitudinal cephalometric follow-up of X-ray films of patients with a complete unilateral cleft lip and palate during puberty. Carthesian x, y coordinates of the total of 22 landmarks on the lateral films of 25 patients with the same diagnosis and therapy were established, which served as outcome data for shape analysis. The changes in facial shape experienced by patients between their 10th and 15th year were evaluated by the thin-plate splines (TPS) method. We used the TPS method to find a function which transforms the shape of the face at the age of 10 as well as the square TPS grid into the facial shape at the age of 15 years with the deformed TPS grid. With the help of Geometric PCA for Bookstein's coordinates we found individuals with different shapes who develop abnormally during puberty and whose development is not well predictable. During puberty the face becomes relatively elongated. The most pronounced deformation is caused by the shift of the first permanent molar anteriorly, or a relative shortening of the frontal part of the dental arch. In the anterior direction the position of landmarks changed only in the area of nose; the alveolar process shows retrusion. The position of the mandible in relation to the maxilla change mainly in the inferior direction; the mandibular angle shifts posteriorly. The shape of skeletal profile was compared with a group of patients with the same diagnosis who underwent different therapy.

The skull of Wolfgang Amadeus Mozart predicates of his death.

W. A. Mozart died due to the consequences of chronic epidural hematoma after sustaining a dull injury to his head, probably at an early age. Exacerbation of the process was repeated over a period of many years and manifested itself as pyrexial disease, meningeal irritation with intense headaches. After the attack subsided, the illness manifested itself again. After the last attack of the likely infected nidus, Mozart died on December 5, 1791. Historic data about the composer's behavior indicate development of a temporal syndrome or temporal epilepsy with typical clinical manifestations.

Predicting the development of jaws in patients with complete unilateral cleft of the lip and palate.

The main objective of this study was to find a predictive multivariate model of jaw development in patients with the most frequent cleft malformation, i.e. complete unilateral cleft lip and palate (UCLP). The prediction is urgently needed from the clinical aspect. It will be possible to detect early adversely developing patients upon whom intensive care and adequate orthodontic treatment could be devoted in good time. The study is based on a long-term cephalometric follow-up of lateral X-rays of 48 boys with UCLP during puberty. Using multivariate methods we investigated the relationship of 75 craniofacial characteristics of size, shape and position during the time interval from 10 to 15 years of age. As the prediction of the development of the jaws in patients with clefts is very complicated, we have attempted to find a reliable predictive system. Sagittal intermaxillary relations can be predicted most accurately in the investigated group by means of the angular dimension Ss-N-Sm (A-N-B angle). We suggest using in clinical practice trinomial equations, the coefficient of determination of which varies round 0.80, and thus the position of the variables can be explained with sufficient accuracy (the coefficient of determination 0.64 is considered in orthodontics a value of predictive significance). The proposed predictive technique was successfully tested in a group of 12 patients with the same diagnosis and therapy.

The effect of age and exercise on wrist mobility.

Wrist mobility was evaluated in university students (52 males and 49 females), seniors (30 males and 30 females) and pianists (21 males and 31 females). We consider the student group as a control with normal mobility. In students we did not notice differences between the right and left wrist motion; however, flexion, radial duction, and range of dorsovolar as well as radioulnar movements were greater in females compared to males. In comparison to students, seniors show limitation of all types of excursions, which is smaller in females than in males (in ulnar duction of females it is insignificant). Differences in mobility between right and left wrist in seniors were not found, while better mobility in females applies to all excursions except flexion. Pianists, compared to students, have greater ulnar duction, and in the case of males also flexion. Hyperextension and radial duction are the same as in the control group. No differences between sides or sexes are apparent. Compared to the control group, the range of dorsovolar and in particular radioulnar motion is greater only in pianist males, while in females the difference is minimal.

The influence of age and exercise on the mobility of hand joints: 3. thumb joints.

Following our previous study about mobility of the three-phalangeal fingers we have measured flexion in the interphalangeal (IPP) and metacarpophalangeal (MPP) thumb joints as well as thumb opposition (hyperadduction) in university students (52 males and 49 females), seniors (30 males and 30 females) and pianists (21 males and 31 females). In the student control group we did not find difference between males and females or right and left hand, unlike in the previous study of three-phalangeal fingers. The MPP has greater flexion variability than the IPP joint. We have recorded greater limitation in all measured movements in seniors, in the thumb opposition significantly greater in males than in females. Pianists, on the other hand, always show greater thumb opposition, while greater flexion was significant only in the MPP joint in males. We did not record a difference between right and left hand in seniors or pianists.

The influence of age and exercise on the mobility of hand joints: 2: Interphalangeal joints of the three phalangeal fingers.

This report is a continuation of the study about mobility of the metacarpophalangeal (MP) joints of the three-phalangeal fingers. We measured flexion of proximal (PIP) and distal (DIP) interphalangeal joints in university students (52 males and 49 females), senior citizens (30 males and 30 females), and pianists (21 males and 31 females). Students were considered as a control group characterized by normal mobility of hand joints. In all three groups, the smallest flexion in the PIP joints is in the little finger, in the DIP joints in the index and ring fingers. In the control group the flexion in the PIP joints is greater in females compared to males, in the DIP joints it is greater on the left side compared to the right. With the exception of DIP joints in females, the situation is also similar in seniors. In pianists, however, the gender and lateral differences are less pronounced, due to exercise. Seniors of both genders show significant limitation of flexion in all PIP as well as DIP joints, as compared to students, while pianists have the same range of flexion compared to students, which also corresponds to the situation in MP joints. The previous study, however, showed that pianists have a greater ability to abduct and hyperextend fingers.

The influence of age and exercise on the mobility of hand joints: 1: Metacarpophalangeal joints of the three-phalangeal fingers.

Mobility of metacarpophalangeal joints (MP) of the three-phalangeal fingers was measured in university students (52 males and 49 females), senior citizens (30 males and 30 females), and pianists (21 males and 31 females). We consider the student data file to be a control group with hand mobility unchanged by external influence. Extension, flexion, and total abduction in this group are greater in the left than the right hand. Only extensions were greater in females compared to males. In seniors, all types of studied movements are, with the exception of total abduction in females, lesser that in the control group. The difference is more apparent in males than in females. Intersexual difference showing better MP joint mobility in females than males is thus greater in seniors than in students; however, greater mobility of MP joints in left compared to right hand is less noticeable. Compared to students, pianists show greater finger abduction, and--less markedly--also passive and active extensions, while we did not notice difference in finger flexion. Intersexual difference in MP joint mobility in pianists were not recorded, and better mobility on the left hand compared to the right hand was evident only in dorso-palmar movements in males (the exception was total finger abduction, which is greater for the left hand in males as well as in females). In the three studied series we did not register differences in interfinger abduction between the left and right hand or between sexes. Active dorso-palmar MP joint range of motion is greatest in the little finger and smallest in the index finger, smallest in seniors and greatest in pianists. In all three groups, the range is greater in the left than the right hand and in females compared to males.

Facial growth and development during the pubertal period in patients with complete unilateral cleft of lip one palate.

The study is based on a long-term cephalometric follow-up of lateral X-ray films of 48 boys with complete unilateral cleft lip and palate during puberty. The configuration of the face was negatively influenced by the reduced depth of the maxilla and limited vertical growth of the upper lip. As compared with the mandible, the maxilla grew less harmoniously in many respects; on the soft profile the depth of the nose increased most intensely. Retrusion of the maxilla led to a deterioration of sagittal intermaxillary relations in almost 92% of patients. In 32% of these patients the deterioration exceeded 3 of the ANB angle, and in 27% a transition from the 1st to the 3rd skeletal class was recorded. 25% of the subjects already belonged in class III at the age of ten years. In 94% of patients during puberty, flattening of the face occurred, which was frequently associated with a sunken upper lip (63%). Due to successful orthodontic treatment it was possible to restore maxillary overjet in 46% of the patients. In subjects who had a maxillary overjet of at least 2 mm at the age of 10 years, it did not change to negative values by the age of 15 years. Patients with more severe impairment of the jaws were treated more frequently by means of fixed appliances, but they did not differ substantially from the other patients in their further development (with the exception of a significant anteinclination of the palate).

Roentgencraniometric analysis of skulls of mammoth hunters from Dolní Vestonice.

The authors assessed roentgenometrically Rank-Xerox images of four well-preserved skulls of gravettian mammoth hunters from Dolní Vestonice (26,000 years ago). The basic structure of the face expressed from lateral images in the shape of a pentagon differs from contemporary and historical populations. As these hunters had a markedly longer mandibular body but not a longer mandibular branch, the craniogram (pentagon) is broad in an anteroposterior direction, while in the contemporary population it is narrower and longer in a vertical direction. With the exception of skull DV XIV, which has a marked posteriorotation of the face, the mandible of the hunters is characterized by definite protrusion, a smaller gonial angle and less steepness of the mandibular body (hypodivergent vertical intermaxillary relations). The maxilla protrudes markedly in DV XIII with a consequently more convex profile and impaired sagittal intermaxillary relations (second skeletal class). In the other skulls the convexity of the face and sagittal intermaxillary relations are consistent with contemporary conditions. In the dental analysis only proclination of the upper incisors in two of three assembled skulls is obvious.

Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly.

OBJECTIVE: To explain the effect of craniofacial relations on the development of the sleep apnoea syndrome (SAS) in acromegaly, and to elucidate how the activity of acromegaly affects the severity of SAS. DESIGN: Prospective observational study. METHODS: Cephalometry and sleep ventilation measurements were performed in 26 acromegalic men and in 96 men with SAS. RESULTS: SAS was found in 20 acromegalic men. Compared with non-acromegalic men with SAS, patients with acromegaly and SAS were found to have: enlargement of almost all linear dimensions; increased angle indicating mandibular protrusion; increased difference between maxillary and mandibular protrusion; articular angle decrease; soft palate lengthening; and pharyngeal airway space (PAS) enlargement in the palatal and uvular-tip planes. A comparison of acromegalic men with and without SAS revealed no significant difference in the craniofacial skeleton, although there was a narrowing of the minimal PAS (MinPAS) and of PAS in the uvular-tip plane in patients with SAS. SAS was more frequent in the patients with active acromegaly. MinPAS in the patients with active acromegaly was narrower than in those without disease activity. CONCLUSION: Skeletal abnormalities in acromegalic men with SAS were different from those in SAS patients without acromegaly. Upper airway narrowing due to changes in pharyngeal soft tissues takes a more relevant share in the development of SAS in acromegalic men than skeletal anomalies.

Optical non-contact 3D profilometry of the palate in subjects with cleft lip and/or palate.

Within the framework of a research project concerning hard palate morphometry in facial clefts, optical non-contact 3D profilometry based on the Fourier transform method was applied. The article discusses the principle of Fourier transform profilometry, the procedure for image acquisition and processing, as well as the merits of this method in the study of palate morphology.

[Comparison of cephalometric parameters in patients with sleep apnea syndrome and normal individuals]. / Srovnání cefalometrických parametru nemocných se spánkovým apnoickým syndromem s normou.

BACKGROUND: Craniofacial abnormalities which predispose to pharyngeal obstruction can be detected by cephalometry. The aim of the present study was to compare cephalometric findings of the patients with sleep apnoea syndrome (SAS) with those of healthy population. METHODS AND RESULTS: The SAS patients (23 females, 96 males) and normal population (36 females, 50 males) were examined by cephalometry. In the group of females with SAS following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), mandibular retrognathism (p < 0.05), micrognathism of the mandible (p < 0.001), dorsocaudal rotation of the mandible (p < 0.01), increased lower gonion angle (p < 0.001) and the articular angle (p < 0.05), increased anterior facial height (p < 0.05), narrowing the depth of bony framework of the nasopharynx (p < 0.001), decreased depth of the upper face (p < 0.01) and decreased length of the cranial base (p < 0.01). In the group of males with SAS, following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), decreased depth of the maxilla (p < 0.001), decreased angle of the cranial base (p < 0.01), decrease saddle angle (p < 0.01), decreased depth of the upper face (p < 0.01), increased lower gonion angle (p < 0.01), increased articular angle (p < 0.001) and increased anterior and posterior facial height (p < 0.001). CONCLUSIONS: There are important differences in orofacial skeleton and soft tissue of the nasopharynx measured by cephalometry in the patients with sleep apnoea compared to normal population.

Facial growth in adulthood after primary periosteoplasty or primary bone grafting in UCLP.

OBJECTIVE: The primary research aim of this study was to compare long-term differences in craniofacial morphology at adulthood between two groups of unilateral cleft lip and palate (UCLP) patients: one operated by primary periosteoplasty and the other by primary bone grafting. DESIGN: The two groups were followed longitudinally at 5-year intervals; this study examined the 15- to 20-year age range. SETTING: University hospital/center located in Prague, Bohemia, Czech Republic. PATIENTS: 17 men with primary bone grafting, 29 men with primary periosteoplasty. INTERVENTIONS: Primary bone grafting or periosteoplasty. METHODS: Serial cephalometric radiographs. MAIN OUTCOME MEASURES: Conventional cephalometric and finite element measures. RESULTS: The mandibular symphysis was larger in the bone-grafted group. The periosteoplasty group displayed a more horizontal growth of the mandible with less rotation than the bone-grafted group. There were no other significant differences. CONCLUSIONS: We conclude that the original outcomes differences observed in childhood and adolescence were masked by skeletal and dental compensations in adulthood. These observations can be attributed to both natural growth and clinical intervention.

Bioceramics as an option in correction of facial skeleton deformities.

The removal of certain deformities of facial bones is a prerequisite to a restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative technique would represent an inadequate burden for a patient. A result is achieved in one surgical intervention with low costs and low demands on technical equipment. Biocompatible nonresorbable glass-ceramics based on oxyfluoroapatite and wollastonite presenting osteoconductivity permits osteointegration, i.e., direct physicochemical bonds between live bone tissue and the implant without formation of a fibrous capsule. It presents better durability to stress in simulated body fluid than the usually used hydroxyapatite. It was used for restoration of facial skeletal framework contour in 14 cases under conditions where prior solutions were doubtful. Good results were reached in all patients. The mean time of observation was 18 months. During that period, the rate of complications was 14.3%. This approach may be found to be a suitable technique, especially for patients exhausted by prior unsuccessful treatment but still not acquiesced in a result.

Multivariate comparison of craniofacial morphology in different types of facial clefts.

Based on X-ray measurements of the head of 187 adult men with cleft lip and/or palate, the authors compared, using the multivariate method, deviations in the craniofacial morphology between different types of clefts in the following seven groups: cleft lip alone, complete and incomplete isolated cleft palate, cleft of the soft palate only, unilateral complete and incomplete and bilateral complete cleft lip and palate. The X-ray films were evaluated according to Jarabak's method. A special position is held by cleft lip alone with minimal skeletal and dental effects. Isolated clefts of the palate display in skeletal analysis the same basic deviations as clefts of the lip and palate; in dental analysis the deviations are smaller (in particular there is no retroinclination of the upper incisors). The effect is much milder in isolated clefts of the soft palate. In cleft lip and palate there is, in contrast to isolated clefts of the palate, retrusion of the mandible; in bilateral clefts, in conjunction with persisting protrusion of the premaxilla the depth of the upper jaw is not reduced, the facial skeleton is not flattened and the sagittal intermaxillary relations are not impaired. In the basic developmental pattern there is, however, no difference between different types of clefts which affect the palate (probably in conjunction with postoperative sequelae). The variable which differentiates most types of clefts in the skeletal analysis is the depth of the maxilla; in the dental analysis it is the interincisal angle, which is, however, influenced by treatment. Jarabak's analysis can record the basic deviations of the configuration of the bony face with a cleft but does not detect some important characteristics such as the vertical proportionality of the face and the posteroposition of the maxilla. The assessment of the soft profile is, however, inadequate and unsuitable.

Effect of primary repositioning of the nasal septum on facial growth in unilateral cleft lip and palate.

OBJECTIVE: The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate. DESIGN: Roentgencephalometric investigation. SETTING: Cleft Centre at the Clinic of Plastic Surgery, Prague. PATIENTS: Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age. INTERVENTIONS: The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group. MAIN OUTCOME MEASURES: Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator. RESULTS: Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups. CONCLUSIONS: Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.

Craniofacial abnormalities in sleep apnoea syndrome.

One hundred and four men with the suspected diagnosis of sleep apnoea syndrome (SAS) not suffering from neuromuscular diseases or acromegaly were examined by X-ray cephalometry. Subjects suffering from bronchial obstruction, laryngeal carcinoma, suspected Treacher Collins syndrome as well as subjects in whom SAS was not verified were excluded. The remaining 81 men were divided into two groups depending upon disease severity as expressed by the mean index of oxygen desaturations per hour (less than 30-group A; more than 30-group B). In group B, the following parameters were significantly altered as compared with group A: dorsocaudal rotation of the mandible, elongation of the soft palate, and an increase of the saddle angle, increase of the angle of the cranial base, the lower gonion angle and the angle of the inclination of the mandible. Differences in the size of the soft palate, the rotation of the mandible and the size of the lower gonion angle can be found not only between healthy and subjects with SAS but also between subjects with mild and severe apnoea.

Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. DESIGN: The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). SETTING: The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. PATIENTS: The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. INTERVENTIONS: Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. RESULTS: The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. CONCLUSION: Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.