Determinantes sociales adversos y riesgo de labio y paladar fisurados, estudio de casos y controles. Ciudad de Cuenca. 2010-2015. / Adverse social determinants and risk of cleft lip and palate Study of cases and controls. Cuenca city. 2010-2015

Introduction Orofacial Cleft, in particular cleft lip and palate (LPF) constitute a problem of oral health due to its implications and impact in several aspects; Little has been studied of how much socioeconomic factors determine this pathology, such as: the place of housing, whether rural or urban, the age and educational level of the mother and socioeconomic. The objective was to determine the association between age and educational level of the mother at the time of delivery, the area of residence, access to folic acid consumption and socioeconomic level (social determinants) with the risk of having a child with cleft lip and palate in the city of Cuenca. Methodology. An observational, analytical, retrospective study of 138 cases (patients with cleft lip and palate) of hospitals Vicente Corral Moscoso and José Carrasco Arteaga and 162 controls of the same hospitals; Results. The association between socioeconomic level and LPF diagnosis shows an OR = 5,077 (CI 3,098-8,320) p <0.01. The association between the age of the mother and the diagnosis of LPF shows an OR = 1,782 (CI 1,090-2,911) for age at risk (adolescent mother and aged mother) p <0.021 and the association between the mother's educational level and the LPF diagnosis showed an OR = 6,106 (CI 3,690-10,105) p <0.000. The association between folic acid consumption by the mother and the diagnosis of LPF OR = 2,791 (IC 1.687-4.167) p <0.000 Conclusions. There is an interaction between the studied variables (place of residence, mother's level of education, folic acid consumption in pregnancy and socioeconomic level) that determine a higher probability of having a child with LPF.

Introducción Las fisuras orofaciales, en particular la de labio y paladar fisurado (LPF), constituyen un problema de salud bucodental debido a sus implicaciones en varios aspectos; Poco ha sido estudiado los factores socioeconómicos: lugar de vivienda, edad, nivel educativo y socioeconómico de la madre. El objetivo determinar la asociación entre la edad y nivel educativo de la madre en el momento del parto, la zona de residencia, el acceso al consumo del ácido fólico y el nivel socioeconómico, con el riesgo de tener un hijo con LPF. Metodología: observacional, analítico, retrospectivo; se analizó 138 casos (pacientes con LPF) del hospital Vicente Corral Moscoso y José Carrasco Arteaga y 162 controles de los mismos hospitales. Resultados. La Asociación entre el nivel socioeconómico y el diagnóstico de LPF muestra un OR=5.077 (IC 3.098-8.320) p<0.01. La Asociación entre la edad de la madre y el diagnóstico de LPF muestra un OR= 1.782 (IC 1.090-2.911) para la edad en riesgo (madre adolescente y madre añosa) p<0.021 y la Asociación entre el nivel educativo de la madre y el diagnóstico de LPF muestra un OR= 6.106 (IC 3.690-10.105) p<0.000. La Asociación entre el consumo de ácido fólico por la madre y el diagnóstico de LPF OR= 2.791 (IC 1.687-4.167) p<0.000 Conclusiones. Existe interacción entre las variables lugar de residencia, nivel de instrucción de la madre y consumo de ácido fólico en el embarazo y el nivel socioeconómico que determinan mayor probabilidad de tener un hijo con LPF.

Anquiloglosia y problemas de succión, tratamiento multidisciplinar: terapia miofuncional orofacial, sesiones de lactancia materna y frenotomía / Ankyloglossia and breastfeeding problems, multidisciplinary management: Orofacial myofunctional therapy, breastfeeding sessions and frenotomy

Introducción. La limitación de la movilidad lingual en neonatos puede ocasionar problemas en la lactancia, entre ellos: dolor-grietas-mastitis en la madre, mal progreso de peso del neonato y duración excesivamente larga de las tomas. El objetivo de este trabajo es evaluar la efectividad de los tratamientos realizados en los pacientes con anquiloglosia y trastornos de succión. Material y métodos. Estudio descriptivo preliminar de la efectividad del circuito establecido entre los servicios de Cirugía Oral y Maxilofacial, Logopedia y Rehabilitación Orofacial y Lactancia Materna para el tratamiento de los pacientes que acuden con problemas de lactancia materna y se les diagnostica anquiloglosia. Resultados. Se trató a 61 pacientes de edades entre 0 y 6meses con anquiloglosia asociada a problemas clínicos relacionados con la lactancia: 20 niñas (32.8%) y 41 niños (67.2%). Se establecieron 3 grupos según el tratamiento realizado: grupo1 (n=6) únicamente las sesiones de lactancia materna (SLM), grupo2 (n=19) terapia miofuncional (TMF) y asesoramiento en SLM, y grupo3 (n=36) frenotomía y siguieron TMF y asesoramiento de SLM. La anquiloglosia tipoiii es el frenillo lingual más frecuente (57.4%). En el total de la muestra se observaron mejorías en los parámetros que valoran la efectividad y el confort de la lactancia materna. Conclusiones. Mejorar la succión es posible; se recomienda estimular la succión con terapia miofuncional antes y después de la frenotomía, y también en aquellos casos en los que no será necesaria la cirugía (AU)

Introduction. The limitation of lingual mobility in newborns can cause problems in lactation. Among these problems are, soreness, cracked nipples or mastitis in the mother, poor weight gain of the newborn, and an excessively prolonged period of time in each breastfeed. The aim of this study is evaluate the effectiveness of the treatment received by the newborns with breastfeeding problems and ankyloglossia. Material and methods. A preliminary study of the effectiveness of the circuit established between the Oral and Maxillofacial Surgery, Speech Therapy and Orofacial Rehabilitation and the Breastfeeding Department to treat patients that attended the hospital with breastfeeding problems and were diagnosed with ankyloglossia. Results. A total of 61 patients with ages between 0 and 6 months had ankyloglossia were seen due to clinical problems related to breastfeeding. Of these, 20 (32.8%) were girls and 41 (67.2%) were boys. Three groups were established in accordance with the treatment carried out: group1 (n=6) solely from the Breastfeeding Sessions (BFS), group2 (n=19) Myofunctional Therapy (MFT) and BFS, and group3 (n=36) Frenotomy, followed by MFT and BFS. Ankyloglossia type3 was the most frequent lingual frenulum (57.4%). From the total sample, improvements were observed in the parameters that assessed the effectiveness and comfort of breastfeeding. Conclusions. Improving breastfeeding is possible, and in some cases, surgery should not be necessary. If surgery is required, it is recommended to stimulate suction before and after the frenotomy with myofunctional therapy (AU)

Direct intralesional ethanol sclerotherapy of extensive venous malformations with oropharyngeal involvement after a temporary tracheotomy in the head and neck: Initial results.

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of direct intralesional ethanol sclerotherapy for venous malformations (VMs) with oropharyngeal involvement after a temporary tracheotomy. METHODS: A retrospective assessment was carried out to evaluate the efficacy of direct intralesional ethanol sclerotherapy on 21 consecutive patients presenting with extensive VMs involving the oropharynx in the head and neck and who had undergone tracheotomy. RESULTS: Of the 21 patients, 4 were treated once and 17 were treated from 2 to 5 times. The duration of follow-up was, on average, 9.1 months. Of the 21 patients, 7 (33.3%) had complete palliation, whereas the rest (66.7%) achieved partial palliation. Minor complications occurred in 12 of the 21 patients. CONCLUSION: Direct intralesional ethanol sclerotherapy after a temporary tracheotomy is a safe and effective treatment for extensive VMs involving oropharyngeal areas of the head and neck. © 2016 Wiley Periodicals, Inc. Head Neck 39: 288-296, 2017.

Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais / Primary treatment of lip and nasal deformity in unilateral cleft lip or cleft lip and palate

Introdução: A fissura labiopalatina é a deformidade congênita mais frequente dentre as malformações craniofaciais, afetando principalmente o lábio superior, nariz e palato. A realização da queiloplastia associada à rinoplastia primária em tempo único é uma tendência. Avaliamos a correlação entre a gravidade da fissura, a idade cirúrgica e a qualidade estética do resultado pós-operatório. Métodos: Foram avaliados 26 pacientes com fissuras labiais ou labiopalatinas unilaterais, com idades entre 3 e 12 meses, operados pela técnica de queilorrinoplastia de Göteborg/McComb. Foi feita uma avaliação fotográfica do pré e pós-operatório por cinco cirurgiões plásticos separadamente e os dados analisados. Resultados: A idade média de realização do procedimento foi de 6,5 ± 3,15 meses, sendo que somente sete pacientes (26,9%) foram operados na idade de 3 meses preconizada pelo protocolo. Foi encontrada correlação entre a gravidade da fissura e a qualidade dos resultados, ao mesmo tempo em que não foi encontrada associação entre a idade da cirurgia e os resultados. Todos os casos do estudo foram considerados ótimos ou satisfatórios. Conclusões: A utilização de uma técnica de queiloplastia que seja de fácil reprodutibilidade, com bons resultados estéticos, e que possa ser utilizada em conjunto com outras técnicas de tratamento primário do nariz é uma boa opção a ser adotada por centros de tratamentos deste tipo de paciente. A gravidade da fissura é um fator importante na qualidade dos resultados. Quanto mais grave a fissura os resultados tendem ser piores. A idade da cirurgia, neste estudo, não teve correlação com a qualidade nos resultados.

Introduction: Cleft lip and palate, the most frequent congenital craniofacial deformity, mainly affects the upper lip, nose, and palate. One possible treatment is single-stage lip repair with primary rhinoplasty. Here we assessed the correlations among cleft severity, surgical age, and aesthetic results. Methods: A total of 26 patients with unilateral cleft lip or cleft lip and palate aged 3-12 months underwent surgical lip repair associated with the Göteborg/McComb rhinoplasty technique. Steps before and after surgery were separately evaluated by five plastic surgeons using pictures and the data were analyzed. Results: The average patient age at surgery was 6.5 ± 3.15 months, and only seven patients (26.9%) underwent surgery at 3 months of age as recommended by the protocol. Cleft severity and results quality were associated, whereas surgical age and aesthetic results were not correlated. Results in all cases were considered optimal or satisfactory. Conclusions: The lip repair technique, which presents good reproducibility and aesthetic results and can be used with other primary treatment techniques for the nose, should be adopted by treatment centers managing cleft lip and palate. Cleft severity is an important factor in results quality; the greater the severity, the worse the results. In the present study, surgical age was not correlated with results quality.

[TEAS for prevention and treatment of orthodontic toothache and oral dysfunction: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of transcutanclus electrical acupoint stimulation (TEAS) on prevention and treatment of orthodontic toothache and oral dysfunction. METHODS: A total of 85 patients of malocclusions in the preliminary diagnosis were randomly divided into a control group (20 cases), a psychological intervention group (22 cases), a medication group (20 cases) and a TEAS group (23 cases). Orthodontics treatment was given in all the groups. Patients in the control group received no further treatment; patients in the psychological intervention group received comprehensive psychological intervention, including cognitive education and music therapy; patients in the medication group received oral administration of ibuprofen; patients in the TEAS group received TEAS at Juliao (ST 3), Jiachengjiang (Extra) and auricular point Ya (LO1). The treatment was given twice a day, one in morning and one at night, for 7 days. The pain scores of orthodontic toothache and changes of oral dysfunction were observed in all groups. RESULTS: (1) At 5 time points from the 12th hour to the 4th day, the scores of spontaneous pain in TEAS group were lower than those in the control group (all P < 0.01); during the time points, the scores in TEAS group were lower than those in the psychological intervention group (P < 0.05, P < 0.01), which were similar to those in the medication group (all P > 0.05). (2) During the peak cycle of spontaneous toothache, the scores of irritation pain in TEAS group were significantly lower than those in the control group (all P < O.01), regardless of time-point statistics or general statistics; the scores of irritation pain in the TEAS group were also significantly lower than those in the psychological intervention group (all P < 0.01), which were similar to those in the medication group (all P > 0. 05). (3) Compared with control group, the grading of talking disorder in the remaining groups did not change significantly (P > 0.05). (4) Compared with control group, the grading of moderate-severe eating disorder in TEAS group was significantly reduced (P < O.05), which was not different from that in the medication group (P > 0.05). The differences of the grading of moderate-severe eating disorder were not significantly different between the psychological intervention group and control group (P > 0.05). (5) There were 3 cases of digestive system adverse reactions in the medication group. CONCLUSION: TEAS can efficiently prevent orthodontic toothache and oral dysfunction, which is superior to psychological intervention and similar to medication. In addition, it can avoid possible side-effect of medication.

[Diagnosis and management of ankyloglossia in young children]. / Diagnostic et prise en charge de l'ankyloglossie chez le jeune enfant.

Ankyloglossia is a common condition. Its prevalence is between 3.2% and 4.8% depending on the series and is largely underestimated given the fact of non-diagnosis when the symptoms are limited. It is defined as a short lingual frenulum resulting in a limitation of the lingual mobility. It is due to a defect in cellular apoptosis embryogenesis between the floor of the mouth and tongue. The result is a fibrous and short lingual frenulum. Several classifications were used to make the diagnosis. However, these are the clinical implications, particularly on food and primarily breastfeeding in the baby and phonation in older children that will motivate the management. This is surgical and different techniques are available: infants before the age of 6 months and when the lingual frenulum is still a fine cellular membrane, frenotomy is recommended. Frenectomy with or without frenoplasty is indicated for the older child. The surgery is simple, the results are good and rapidly improving grievances. Complications are rare. Finally, speech therapy is important when there are implications for phonation.

Treatment of ankyloglossia and breastfeeding outcomes: a systematic review.

OBJECTIVE: Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia. METHODS: Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched up to August 2014. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics and outcomes and assigned quality and strength-of-evidence ratings. RESULTS: Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. We included comparative studies published in English. The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longer-term breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation. CONCLUSIONS: A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.

Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review.

BACKGROUND AND OBJECTIVE: Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding difficulties and social concerns. We systematically reviewed literature on feeding, speech, and social outcomes of treatments for infants and children with ankyloglossia. METHODS: Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data on study populations, interventions, and outcomes and assessed study quality. RESULTS: Two randomized controlled trials, 2 cohort studies, and 11 case series assessed the effects of frenotomy on feeding, speech, and social outcomes. Bottle feeding and social concerns, such as ability to use the tongue to eat ice cream and clean the mouth, improved more in treatment groups in comparative studies. Supplementary bottle feedings decreased over time in case series. Two cohort studies reported improvement in articulation and intelligibility with treatment. Other benefits were unclear. One randomized controlled trial reported improved articulation after Z-frenuloplasty compared with horizontal-to-vertical frenuloplasty. Numerous noncomparative studies reported speech benefits posttreatment; however, studies primarily discussed modalities, with outcomes including safety or feasibility, rather than speech. We included English-language studies, and few studies addressed longer-term speech, social, or feeding outcomes; nonsurgical approaches, such as complementary and alternative medicine; and outcomes beyond infancy, when speech or social concerns may arise. CONCLUSIONS: Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia.

Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management.

Examination of the oral cavity can provide significant diagnostic information regarding the general health of the patient. The oral cavity is affected by a multitude of pathologic conditions of variable cause and significance; however, there are numerous normal variations of oral soft tissue structures that may resemble a pathologic state. Understanding these variations assists practitioners to discriminate between normal versus abnormal findings and determine the appropriate course of management, if necessary.

Attention to rhotacism language problem by oral surgery and vibrostimulatory therapy: a case report / Tratamiento para el problema del lenguaje de rotacismo mediante cirugía oral y terapia vibroestimulatoria: reporte de un caso

Ankyloglossia may prevent the tongue from contacting the anterior palate, which promotes an infantile swallow and hamper the progression to an adult-like swallow. This can result in an open bite deformity and in some cases it can be associated to mandibular prognathism and language problems like rhotacism, described as the inability or difficulty in pronouncing the sound / r /. The surgical cut of the frenum tissue that connects the tongue to the jawbone (frenulectomy) and the language rehabilitation treatment with functional oral devices, represent an alternative treatment for this problem. An 11-year-old boy reported with language performance problems, dental malposition and diagnostic of ankyloglossia condition, received frenulectomy surgery and language rehabilitation treatment with functional oral devices during six months. Language diagnosis was carried out in three periods of time: prior to the surgery, four weeks after the surgery and six months later. Combined surgical and functional therapies proved to be a better alternative than only surgical therapy. Combined therapies increased the speech abilities as well as swallowing functions, therefore, the patient's self-esteem.

La anquiloglosia puede evitar que la lengua entre en contacto con la región anterior del paladar, lo que promueve una deglución infantil y dificultan la adecuada deglusión en el adulto. Esto también puede dar lugar a una mordida abierta y en algunos casos, estar asociada con prognatismo mandibular y problemas de lenguaje como el rotacismo, que se describen como la incapacidad o dificultad para pronunciar el sonido / r /. La exsición quirúrgica del tejido que conecta frenillo de la lengua a la mandíbula (frenectomía) y el tratamiento rehabilitador del lenguaje con dispositivos orales funcionales, representan una alternativa de tratamiento para este problema. Un niño de 11 años de edad, con problemas de lenguaje, malposición dental y diagnóstico de anquiloglosia, fue sometido a frenectomía y tratamiento de rehabilitación dellenguaje mediante dispositivos orales funcionales durante seis meses. El diagnóstico del lenguaje se llevó a cabo en tres periodos de tiempo: antes de la cirugía, cuatro semanas después de la cirugía y seis meses más tarde. La combinación de tratamiento quirúrgico y funcionales demostraron ser una alternativa mejor que la terapia quirúrgica por sí sola. Las terapias combinadas aumentaron la capacidad del habla, así como funciones de deglución, por lo tanto, la autoestima del paciente.

Uniformity in selection for subsidized orthodontic care--focus on borderline treatment need.

In the county of Stockholm, subsidized orthodontic care is offered to roughly 25% of persons under the age of 19. Stockholm County Council has signed contracts with experienced orthodontists (consultants) to carry the responsibility of screening and offering subsidized treatment to those having the most urgent treatment need. For this purpose the orthodontist is free to use whatever yardstick he/she finds most useful. The Swedish Medical Board Index (SMBI) is most commonly used, and was used by the consultants in this study. It is obvious that the selection process under these conditions must be affected by a subjective opinion and consequently the inter-examiner variation would be large, especially for subjects presenting with borderline treatment need. The aim of the study was to evaluate the uniformity in selection of subjects for subsidized orthodontic care with focus on borderline treatment need. Six consultant orthodontists volunteered to participate. Each orthodontist was asked to recruit patients whom they considered to have borderline treatment need. 34 adolescents; 25 girls and 9 boys (mean age 14.5 +/- 1.68 years), were recruited. These patients were individually assessed by each orthodontist. The interexaminer agreement was tested by use of Cohen's kappa statistics (kappa = 0.324). Since all six orthodontists fully agreed in only one third of the cases the validity of the assessments with the present guidelines is insignificant, at least in subjects with borderline treatment need.

Sclerotherapy of microcystic lymphatic malformations in oral and facial regions.

PURPOSE: Lymphatic malformations (LMs) are benign vascular lesions that can cause disfigurement and functional impairment. Complete surgical resection is often difficult and intralesional injection of sclerosing agents has been proposed as an alternative to the surgery. The aim of this study was to review our experience with pingyangmycin (bleomycin A(5)) injection alone or in combination with surgery for treatment of oral and facial LMs, and to observe the histologic changes after intralesional injection of pingyangmycin. PATIENTS AND METHODS: Seventy-nine patients who received intralesional injection of pingyangmycin for the treatment of oral and facial LMs were reviewed. There were 47 males and 32 females, at a ratio of 1 to 0.68. Age ranged from 4 months to 17 years. The sites of the lesions occurred primarily in the tongue, which was found in 37 cases, followed by cheeks in 18, involved lips in 10, parotid gland in 7, oropharynx in 5, and floor of the mouth in only 2 cases. Among them, 42 patients received pingyangmycin sclerotherapy solely, 14 patients had sclerotherapy in combination with secondary surgery, and 23 other patients had surgery with sclerotherapy. Patients had been followed up more than 6 months after the last treatment. The rating of the results was 4-graded: excellent, good, fair, and poor (based on clinical outcome). The histologic changes were observed under microscope in 14 resected specimens after the sclerotherapy. RESULTS: Primary anatomic locations of 79 LMs involved the face in 25 cases, and the oral cavity in 54. Median number of injections received per child was 4.2 (range, 3 to 8). Among the 79 patients, 44 cases (55.7%) were graded as excellent, 23 cases (29.11%) as good, 10 cases (12.66%) as fair, and 2 cases (2.53%) as poor. There were fewer totally cured or near-normal appearance in the sole sclerotherapy group (42.86%) than in the surgery with the sclerotherapy group (73.91%; P< .05). In specimens resected after pingyangmycin injection, histologic examination showed the destructive lymphatic vessels and obvious stromal fibrosis. CONCLUSIONS: Intralesional injection of pingyangmycin was effective for over two thirds of the children with oral and facial LMs. Perioperative sclerotherapy may improve the treatment of these malformations.

Recursos empregados pela prótese buco maxilo facial na reabilitação das malformações de lábio e palato / Resources employed for maxillofacial prothesis in the rehabilitation lip and palate malformations

O tratamento das malformações de lábio e palato inicia-se com o nascimento da criança acometida até a correção ortodôntica dos dentes permanentes. O uso de placas de amamentação obturadores palatofaringeanos, modeladores nasais e outros dispositivos para melhorar a condição física e psicológica dessa criança é de responsabilidade da I Prótese Buco Maxilo Facial, sendo que todos os autores ressaltam a importância da presença de uma equipe multi-profissional e o fiel entrosamento entre seus componentes. A intenção deste estudo é através de uma revisão da literatura, mostrar os avanços e pesquisas da prótese Buco Maxilo Facial na área de malformações.

The influence of craniofacial growth in a case of transverse facial cleft.

This report presents the case of a female patient bearing a right-side transverse facial cleft. She has received interdisciplinary treatment since birth. At regular intervals, dental casts were made, and profile and full-face photographs, lateral and postero-anterior cephalograms were taken during the course of orthodontic treatment and maxillofacial surgery. We evaluated her diagnostic records with the intent of documenting the effects of growth and therapy on the skeletal structures of the facial cranium and on occlusion, and to show the influence on facial esthetics. Her facial morphology and occlusion were manifest at birth and in the primary dentition. The maxilla and mandible deviated from the midsagittal plane toward the cleft side, with the mandible considerably more affected, revealing a markedly posterior position. The lateral skeletal deviation of both jaws increased slightly during growth, yet the midline deviation of the dental arches and malocclusion clearly worsened. The increasing deviation was not obvious in full-face photographs. Especially in the primary and mixed dentition, the mandible shifted to the anterior, which was visible in both the lateral cephalograms and profile photographs. On the whole, however, no noteworthy alteration in the character of the craniofacial morphology occurred by the time growth was complete, despite functional jaw-orthopedic and maxillofacial surgical treatment consisting of two distraction osteogenesis procedures.

Recession occurrence in patients treated with fixed appliances--preliminary report.

PURPOSE: The aim of the study was to evaluate the dependence of gingival recession, malocclusion and factors that may lead to recessions of the gingiva in patients applying for orthodontical treatment. MATERIAL AND METHODS: The study involved 52 randomly selected patients treated with fixed appliances due to occlusal irregularities and dental abnormalities. Data obtained from the examination and selected parameters from cephalometric analysis were placed in a chart including ANB skeletal class and Wits parameter, lower incisor position IMPA, dental abnormalities, extractions due to orthodontical indications and recession etiopathic factors. Statistical analysis of obtained data was conducted using variance analysis. Statistically significant were assumed those calculations for which value of significance level p < or = 0.05. RESULTS: Recession was observed in 18 patients of the 52 examined. Skeletal I class was found in 11 patients (61.12%) and in 8 cases Wits parameter corresponded with skeletal class III (44.4%). Among the patients examined normal incisor inclination was observed in 6 patients (33.33%), whereas 12 cases revealed inclination irregularities (66.66%). Clinical examination disclosed dental defects in 13 patients (72.22%) and in 12 cases recession etiopathic factors were recognized (66.66%). Statistically significant differences between periodontal biotype and gingival recession of 43, 31, 33 teeth were estimated. CONCLUSIONS: Anatomical factors, malocclusion and dental irregularities were fund to be the main cause of the single and/or multiple recessions. Patients applying for orthodontic treatment due to occlusal abnormalities should remain under particular control in case of symptoms suggesting the incidence of recession, particularly when recessions are already present.

Vertical changes in patients with complete unilateral and bilateral cleft lip, alveolus and palate.

AIMS AND METHODS: Twelve UCLP and eleven BCLP patients who had been treated according to the Hanover treatment protocol were evaluated by means of cephalometric analysis and cast measurements. The aim of this investigation was to demonstrate changes in the vertical plane and in incisor position in the course of craniofacial growth compared to age-matched non-cleft controls. Lateral cephalograms and casts were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a non-cleft control group (n = 20). RESULTS: A vertical growth impairment of the maxilla was registered in patients with cleft lip, alveolus and palate. The maxilla of the cleft patients showed a significant clockwise rotation while the inclination of the mandible remained virtually unchanged. Both upper and lower incisors, which were significantly retruded at the beginning of the late mixed dentition, could be protruded in the course of craniofacial growth, development of the dentition and treatment, but remained retruded in comparison with the non-cleft controls. The posterior midfacial height was highly significantly shorter in both UCLP and BCLP patients at both evaluation timepoints, whereas the anterior lower jaw height was greater than in the control group