Biomedical subjects

G D Singh

Publications and source records attributed to G D Singh.

At least 19 recordsLinked to original sources

PubMed2006

Digital diagnostics: Three-dimensional modelling.

Three-dimensional imaging techniques, such as computed tomograms (CT), structured light, and stereophotogrammetry, can be used to capture three-dimensional coordinate data, but comprehensive analysis is required to transform these techniques into powerful diagnostic tools. The object of this review is to highlight analytical functionality using software developed to study three-dimensional digital imaging and communications in medicine (DICOM) based digital data for diagnosis, planning of treatment, and evaluation of craniofacial changes. My specific aim was to apply three-dimensional software routines using geometric morphometrics or conventional measurements. These routines rely on robust algorithms to construct mean objects by manipulating the three-dimensional x, y, and z coordinates of all the objects' vertices. Conventional measurements and statistical tests can then be applied to the changes in the vertices, say, before and after treatment. Using graphical and geometric morphometric techniques such as finite-element analysis and principal components analysis, clinical craniofacial modelling can be used for the localisation and quantification of soft and hard tissue changes; diagnostic modelling can be undertaken for planning of treatment, and data-driven predictive modelling can be undertaken for the planning of many procedures based on the surgeon's own experience, patients, and resources. Three-dimensional modelling of digital data may therefore have added value for clinical diagnosis, and planning and assessment of treatment, including audit.

Algorithms↗

PubMed2006

3D airway changes.

Explore the source record for details and available documents.

Airway Obstruction↗

PubMed2006

Synthesis and bronchodilator activity of new quinazolin derivative.

Taking lead from a naturally occurring quinazolin vasicine, a number of compounds were developed and evaluated for bronchodilator and anti-allergic activities. One of these compounds was 2,4-diethoxy-6,7,8,9,10,12-hexahydroazepino[2,1-b]quinazolin-12-one, hereinafter named 95-4, exhibited marked bronchodilator activity evaluated on contracted trachea or constricted tracheo-bronchial tree. On intestinal smooth muscle too it showed relaxant effect. Tracheal relaxant effect was not found to be mediated through beta-adrenoceptors. Cumulative dose-response study with acetylcholine and histamine indicated for its non-specific direct effect on smooth muscles. 95-4 was found to be more potent than theophylline and less to that of salbutamol on dose basis. Tested by a number of experimental models, it was found devoid of anti-allergic activity. It was also found to be free from any adverse effect. 95-4 due to its marked bronchial muscle relaxant effect can find use in conditions associated with spasm of bronchial muscles.

Alkaloids↗

PubMed2006

Inhibition of early and late phase allergic reactions by Euphorbia hirta L.

A 95% ethanol extract from whole aerial parts of Euphorbia hirta (EH A001) showed antihistaminic, antiinflammatory and immunosuppressive properties in various animal models. EH A001 inhibited rat peritoneal mast cell degranulation triggered by compound 48/80. It significantly inhibited dextran-induced rat paw edema. EH A001 prevented eosinophil accumulation and eosinophil peroxidase activity and reduced the protein content in bronchoalveolar lavage fluid (BALF) in a 'mild' model of asthma. Moreover, the CD4/CD8 ratio in peripheral blood was suppressed. EH A001 attenuated the release of interleukin-4 (IL-4) and augmented interferon-gamma (IFN-gamma) in ovalbumin-sensitized mouse splenocytes. The results were compared with the effects of known compounds, ketotifen, cetirizine and cyclophosphamide. These findings demonstrated that Euphorbia hirta possessed significant activity to prevent early and late phase allergic reactions.

Animals↗

PubMed2006

Dental arch shape and size in Malay schoolchildren with Class II malocclusion.

AIM: To quantify and localise differences in Class I and Class II dental arches in Malay schoolchildren. METHODS: The subjects were 50 Malay schoolchildren (Mean age: 15 + 0.7 years) with either Class I (N = 25) or Class II (N = 25) malocclusions. Fourteen homologous landmarks on the upper and lower study models of the subjects were digitised using MorphoStudio software, and the Procrustes means were computed. The mean Class I and Class II configurations were subjected to ftests and finite element analysis. RESULTS: Normalised upper arch Class I and Class II configurations were statistically different (p < 0.05), but the lower arches were not. However, normalised Class II linear parameters were statistically smaller in the upper arch and larger in the lower arch. The upper Class II dental arch was narrower by 15 per cent and asymmetric changes in size (11-20 per cent) were localised in the labial and buccal regions of the lower Class II arch. CONCLUSIONS: Size and shape differences between Class I and Class II dental arches can be identified with finite element analysis.

Adolescent↗

PubMed2004

Longitudinal craniofacial growth patterns in patients with orofacial clefts: geometric morphometrics.

OBJECTIVE: To demonstrate craniofacial developmental patterns in repaired cleft lip and cleft palate (CLP). DESIGN: Retrospective, longitudinal. SETTING: Center for Craniofacial Disorders, San Juan, Puerto Rico. SAMPLE: Males aged 9 to 17 years: 13 noncleft (NC) Class I occlusion (NCC1); 13 NC Class III malocclusion (NCC3); 12 CLP Class I occlusion (CLPC1); and 15 CLP Class III malocclusion (CLPC3). MAIN OUTCOME MEASURES: Form changes (ages 10, 13, and 16 years), using finite-element scaling analysis. RESULTS: NCC1, 10 to 13 interval: 30% size increase in upper midface (p <.05), mental region (p <.01), mandibular body (p <.05); 13 to 16 interval: 10% to 35% size increase in bimaxillary region and ramus (p <.01). NCC3, 10 to 13 interval: 10% to 40% size increase in posterior cranial base, upper midface, and mandible (p <.05); 13 to 16 interval: 10% to 30% size increase in bimaxillary region (p <.01), especially ramus. CLPC1, 10 to 13 interval: 10% to 15% size increase in posterior cranial base (p <.01), midface (p <.05), and mandibular ramus (p <.05); 13 to 16 interval: 8% to 20% size increase in upper midface (p <.01), lower midface (p <.05), and mandible (p <.05). CLPC3, 10 to 13 interval: no significant changes; 13 to 16 interval: upper midface and cranial base show nonsignificant size decreases, but ramus showed size increase. CONCLUSIONS: Noncleft and CLP Class 1 occlusion groups show similar craniofacial growth patterns. Noncleft Class III groups show excessive cranial and mandibular growth. Class III malocclusion in CLP patients is associated with clinically deficient craniomaxillary growth. Growth guidance may be indicated in children with CLP with unfavorable craniofacial growth patterns.

Adolescent↗

PubMed2003

Effects of the headgear-activator Teuscher appliance in the treatment of Class II Division 1 malocclusion: a geometric morphometric study.

OBJECTIVES: To test the hypothesis that there are no gender differences in the outcomes of patients with class II malocclusion treated with the headgear-activator Teuscher appliance (HATA). DESIGN: Retrospective, longitudinal SETTING AND SAMPLE POPULATION: Puerto Rico and Scotland, UK. Thirty-one patients requiring correction of class II division 1 malocclusions. EXPERIMENTAL VARIABLE: Male and female patients treated using HATA. OUTCOME MEASURES: Mean pre- and post-treatment parameters derived from cephalometry subjected to t-tests, and finite-element scaling analysis (FESA), which localizes and quantifies differences between mean pre- and post-treatment configurations. RESULTS: Post-treatment, cephalometry showed that for both males and females, angle SNA decreased, SNB increased, and lower facial heights increased significantly (p < 0.01). For the female post-treatment configuration, FESA revealed large size increases (approximately 20%) located in the inter-maxillary region, the ramus and mandibular body, and around the nasal and mental regions. Conversely, the lip region was diminished (approximately 20%). Similarly, male post-treatment showed size increases located in the inter-maxillary region that extended into the nasal region and the mandibular body (approximately 10-15%), and around the chin (15%). The lip region was diminished (approximately 5%). CONCLUSION: In the attainment of a normal occlusion, both male and female patients treated for class II malocclusions using HATA exhibit antero-posterior restraint of the maxilla, improvements in the mandible maintaining facial height, and lip changes commensurate with improvements in the soft tissue profile.

Activator Appliances↗

PubMed2003

Soft tissue changes in patients with Class II Division 1 malocclusions treated using Twin Block appliances: finite-element scaling analysis.

To determine changes in soft tissue profile in patients with Class II division 1 malocclusions treated with Twin Block appliances (TBA), 99 pairs of lateral cephalographs were traced and 25 soft tissue landmarks digitized. Procrustes superimposition was used to generate average soft tissue profiles scaled to an equivalent size. Statistical differences between prepubertal, pre- and post-treatment profiles were found using ANOVA (P < 0.001). Similarly, significant differences were found between adolescent, pre- and post-treatment profiles (P < 0.001). Using a colour-coded finite element scaling analysis (FESA) programme to localize size change, male prepubertal post-treatment configurations revealed local increases in size at the labiomental groove (approximately 25%) with negative allometry (size-related form change approximately 5%) in the labial and symphyseal regions. For the female prepubertal post-treatment configuration, local increases in size were conspicuous also at the labiomental groove (approximately 6%). Male adolescent post-treatment configurations revealed increases in size in the nasal, mental, and labiomental groove regions (approximately 18%) with negative allometries associated with the upper and lower lips (approximately 20%). For the female adolescent post-treatment configuration, the labial fissure showed an increase in size (approximately 17%), whereas the upper and lower lips and symphyseal region exhibited negative allometries (approximately 5-15%). For shape change, all soft tissue post-treatment configurations were highly isotropic (uniform shape change) over the entire facial nodal mesh except in the areas of the labiomental region and the labial fissure. Thus, in children and adolescents treated for Class II malocclusions a less pronounced labiomental groove is associated with using TBAs, which may provide a more effective anterior lip seal.

Adolescent↗

PubMed2003

Deformations of the midfacial complex in twins with orofacial clefts.

OBJECTIVE: To investigate the craniofacial morphology in twins with cleft lip and/or palate (OFC) and localize differences, compared with noncleft (NC) twins. DESIGN: Retrospective study. SETTING: School of Dentistry, University of Michigan. SAMPLE: Posteroanterior cephalographs of 32 pairs of dizygotic, concordant, like-sexed twins. The NC group consisted of 20 pairs of noncleft twins. The cleft twin (CT) group consisted of 12 pairs of concordant twins (both exhibited OFC). MAIN OUTCOME MEASURES: Changes in linear distances, differences in form difference matrices, and visualization of deformations of thin-plate spline (TPS) transformation grids. RESULTS: Linear analysis indicated significant reductions in interorbital distance ( approximately 12%; p <.01) and reduced maxillary heights ( approximately 27%; p <.001) in CTs. Euclidean distance matrix analysis strongly supported these findings, confirmed that the form matrices were significantly different (p <.05), and indicated relative decreases in internasal width ( approximately 12%) and maxillary base width ( approximately 10%). The TPS analysis produced a transformation grid that showed superoinferior compression, suggesting that OFC is associated with a downward displacement of the nasomaxillary complex as well as distortion in the region of the maxillary base. CONCLUSIONS: Twins with orofacial clefts differ from their unaffected counterparts by a midfacial skeletal morphology characterized by decreases in interorbital and internasal widths and relatively shorter maxillary basal heights and widths. Although most of these differences appear to be due to compression and regionalized deformation, the resultant inferior displacement of the medial region of the midface concomitant with horizontal widening in the presumptive palatal region may be a development model associated with OFC.

Cephalometry↗

PubMed2002

Morphometric analyses of the mandible in prepubertal craniofacial microsomia patients treated with an inverted-L osteotomy.

To analyze changes in mandibular form associated with an inverted-L osteotomy and autogenous bone graft, preoperative, early postoperative (EPO), and late postoperative (LPO) lateral cephalographs of 14 children (mean age approximately 9 years) with unilateral craniofacial microsomia (CFM) were scanned and nine mandibular landmarks digitized. Average mandibular geometries, scaled to an equivalent size, were generated using Procrustes superimposition. Cephalometry, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analyses were carried out on mean mandibular configurations. Cephalometric results showed increases in oblique mandibular length (approximately 9% on average, P < 0.05) and increased ramus height (P < 0.05). Similarly, using EDMA there were also significant differences (P < 0.05) between the mean preoperative, EPO, and LPO configurations. The most demonstrable EPO change in the mandibular configuration using EDMA was increased oblique length (approximately 11%). This improvement depended on ramus oblique lengths increasing by approximately 26%, ramus height increasing by approximately 25%, and mandibular body length increasing by approximately 5%. For TPS analysis, affine and nonaffine changes contributed to the total spline. In all three comparisons the affine transformation showed an antero-inferior rotation of the mandibular configuration. For nonaffine changes the EPO configuration indicated a supero-inferior stretch of the mandibular configuration. The nonaffine LPO changes maintained the supero-inferior stretch of the mandibular configuration. It is concluded that improvements in the lateral facial profile of CFM patients can be achieved using an inverted-L osteotomy, with little relapse approximately 2 years postoperatively.

Age Factors↗

PubMed2002

Morphospatial analysis of soft-tissue profile in patients with Class II Division 1 malocclusion treated using twin block appliances: geometric morphometrics.

OBJECTIVES: To study soft-tissue profile changes in patients treated with twin block appliances (TBA) for the correction of Class II division 1 malocclusion. The null hypothesis is that soft-tissue profiles do not show any significant improvements associated with TBA treatment. DESIGN: Longitudinal, retrospective. SETTING AND SAMPLE POPULATION: Scotland, UK, using lateral cephalographs of 46 consecutive, prepubertal children (aged 9-11 years) and 55 adolescents (aged 12-14 years) obtained from an orthodontic practice. EXPERIMENTAL VARIABLE: The prepubertal children underwent = 13 months of TBA treatment, while the adolescents underwent = 22 months of treatment. OUTCOME MEASURES: Configurations of 13 digitized homologous landmarks of pre- and post-treatment soft-tissue facial profiles were compared using cephalometry, Euclidean distance matrix analysis (EDMA) and thin plate spline (TPS) analysis. RESULTS: Cephalometry showed that height increases associated with the TBA were in the labiomental areas, and the most significant height decreases were seen in the lip regions. The results of EDMA also indicated significant changes (P < 0.05). The distance between the lips decreased by >5%, with increases in length in the labiomental region. The TPS analysis showed the soft-tissues of the mandibular complex being displaced anteroinferiorly, with anterior displacement of the landmarks of the lip region. These changes showed that the lips were brought into closer proximity with each other, permitting a functional oral seal. Moreover, the labiomental groove became less pronounced, reflecting the underlying dento-alveolar correction. CONCLUSION: Demonstrable improvements in soft-tissue facial profile may be associated with TBA treatment.

Adolescent↗

PubMed2002

Bimaxillary morphometry of patients with class II division 1 malocclusion treated with twin block appliances.

To assess changes in bimaxillary morphology in patients with Class II division I malocclusion treated using Twin Block appliances (TBA), pre- and posttreatment lateral cephalographs of 100 patients seven to 16 years of age were compared. The patients were divided into four groups: (1) prepubertal boys (mean treatment time; 13.6+/-4.0 months), (2) adolescent boys (20.1+/-7.7 months), (3) prepubertal girls (12.3+/-1.4 months), and (4) adolescent girls (22.3+/-6.7 months). Five landmarks were digitized on pre- and posttreatment cephalographs for all groups, and the resulting configurations were analyzed using linear analysis, Euclidean Distance Matrix Analysis (WinEDMA), and Thin Plate Spline (TPS) analysis. Results of linear analysis indicated anteroposterior midfacial distances generally increased in all groups. In contrast, WinEDMA indicated that midfacial distances proportionately decreased in all groups treated with TBA. Graphical analysis with TPS showed anteroposterior compression of the configurations, most marked in the region of Prosthion. The affine components of the configurations following the TBA treatment indicated little deformation, but the nonaffine components demonstrated posterior displacement of Prosthion. Thus, improvements in facial balance following TBA treatment are associated with a relative restriction of anterior displacement within the midfacial complex as well as maxillary dento-alveolar effects. Orthodontic treatment methods exerting growth-inhibitory effects within the maxilla may be useful in the correction of Class II division I malocclusions.

Adolescent↗

PubMed2001

An Indonesian child with orofacial duplication and neurocristopathy anomalies: case report.

The parents of an Indonesian patient were concerned with the facial appearance of their child. A medical, family and social history was taken for the patient with the detection of no specific, systemic abnormalities or unusual conditions, although it was noted that the family lived in an area associated with pollutants. On examination, the facial appearance was asymmetric with inferior displacement of the right eye. The zygomatic-maxillary region appeared to be enlarged and deformed. There was unilateral macrostomia with the upper lip appearing elongated. Intra-oral examination revealed that there was duplication of the maxilla and associated structures. The maxilla had a normal complement of deciduous teeth but gross caries was noted. A supernumerary maxilla appeared to be responsible for the extra-oral, zygomatic-maxillary deformation, and its deciduous dentition was incomplete intra-orally. For the mandibular structures, the tongue was abnormally small, giving the appearance of microglossia. The mandibular dentition appeared to be incomplete with gross caries. Further posteriorly, there appeared to be clefting of the individual soft palates. Photographs and radiological examinations were undertaken but CAT scans were not possible. For patient management, a comprehensive surgical strategy is indicated with full family support, education and cooperation.

Child, Preschool↗

PubMed2001

Localization of mandibular changes in patients with class II division 1 malocclusions treated with twin-block appliances: finite element scaling analysis.

Thirty mandibular landmarks were digitized from cephalographs of 46 children (prepubertal, approximately 10 years old) and 53 adolescents (pubertal, approximately 13 years old) to determine mandibular morphological changes in patients with Class II Division 1 malocclusions treated with Twin-block appliances. Procrustes superimposition computed average geometries and an analysis of variance were performed on the cephalographs. Prepubertal pretreatment and approximately 13-month-posttreatment profiles and pubertal pretreatment and approximately 22-month-posttreatment profiles were statistically different (P <.002). In male prepubertal configurations, a color-coded finite element scaling analysis revealed a conspicuous area of positive allometry ( approximately 12%) in the condylar neck and negative allometry ( approximately 17%) at the apex of the coronoid process. For the female prepubertal configuration, local increases in size were discernible in the condylar neck ( approximately 3%) and in the apex of the coronoid process ( approximately 4%). Comparing male pubertal configurations, finite element scaling analysis revealed marked positive allometry ( approximately 27%) in the condylar neck and negative allometry ( approximately 16%) at the apex of the coronoid process. For the female pubertal configurations, local increases in size were noticeable at the condylar neck ( approximately 15%), with negative allometry ( approximately 9%) in the coronoid process. For shape change, all configurations were highly isotropic over the entire mandibular nodal mesh. Therefore, in growing patients treated for Class II Division 1 malocclusions with Twin-block appliances, condylar growth, coronoid process remodeling, and osteogenesis in corpus and dentoalveolar regions may reflect the correction of the underlying skeletal dysmorphology.

Adolescent↗

PubMed2001

Changes in soft tissue facial profile of craniofacial microsomia patients: geometric morphometrics.

To analyze changes in the soft tissue profile associated with an inverted L osteotomy, preoperative, early postoperative, and late postoperative lateral cephalographs of 13 children with craniofacial microsomia (mean age 9 +/- 2 years) were scanned, and 11 soft tissue landmarks were digitized (digitization errors insignificant; P > 0.05). Cephalometry, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analysis were carried out on the mean soft tissue landmark configurations. Cephalometry indicated that there were very few statistically significant differences in mean measurements pre- and postoperatively. In contrast, EDMA determined that there were significant differences (P < 0.05) between mean preoperative, early postoperative, and late postoperative soft tissue configurations, particularly in the labiomental region. Transformation grids obtained from TPS analysis indicated clockwise rotation of the soft tissue configurations with anteroinferior elongation in the labiomental region. Geometric morphometrics indicated that the soft tissue lower facial height increased secondary to the associated underlying skeletal change, improving the profile of patients treated with an inverted L osteotomy of the mandible for the correction of craniofacial microsomia.

Cephalometry↗

PubMed2000

Mandibular transformations in prepubertal patients following treatment for craniofacial microsomia: thin-plate spline analysis.

To analyze correction of mandibular deformity using an inverted L osteotomy and autogenous bone graft in patients exhibiting unilateral craniofacial microsomia (CFM), thin-plate spline analysis was undertaken. Preoperative, early postoperative, and approximately 3.5-year postoperative posteroanterior cephalographs of 15 children (age 10+/-3 years) with CFM were scanned, and eight homologous mandibular landmarks digitized. Average mandibular geometries, scaled to an equivalent size, were generated using Procrustes superimposition. Results indicated that the mean pre- and postoperative mandibular configurations differed statistically (P<0.05). Thin-plate spline analysis indicated that the total spline (Cartesian transformation grid) of the pre- to early postoperative configuration showed mandibular body elongation on the treated side and inferior symphyseal displacement. The affine component of the total spline revealed a clockwise rotation of the preoperative configuration, whereas the nonaffine component was responsible for ramus, body, and symphyseal displacements. The transformation grid for the early and late postoperative comparison showed bilateral ramus elongation. A superior symphyseal displacement contrasted with its earlier inferior displacement, the affine component had translocated the symphyseal landmarks towards the midline. The nonaffine component demonstrated bilateral ramus lengthening, and partial warps suggested that these elongations were slightly greater on the nontreated side. The affine component of the pre- and late postoperative comparison also demonstrated a clockwise rotation. The nonaffine component produced the bilateral ramus elongations-the nontreated side ramus lengthening slightly more than the treated side. It is concluded that an inverted L osteotomy improves mandibular morphology significantly in CFM patients and permits continued bilateral ramus growth.

Bone Transplantation↗

PubMed2000

Comparison of mandibular morphology in Korean and European-American children with Class III malocclusions using finite-element morphometry.

The purpose of this study was to determine whether the morphology of the mandible differed in subjects of diverse ethnic origin exhibiting Class III malocclusions. Lateral cephalographs of 147 children of either Korean or European-American descent aged between 5 and 11 years were compared. The cephalographs were subdivided into seven age- and sex-matched groups, traced, and eight mandibular homologous landmarks digitized. Average mandibular geometries, scaled to an equivalent size, were computed using Procrustes superimposition and subjected to ANOVA. Graphical analysis using a colour-coded finite element (FEM) programme was used to localize differences in morphology. Results indicated that the overall mean Korean and European-American mandibular configurations differed statistically (P < 0.001) and statistical difference was maintained at all age-wise comparisons. Comparing Korean and European-American Class III mandibular configurations for local size-change, FEM analysis revealed that the Korean condylar and mental regions generally were smaller (approximately 15-20 per cent decrease in size, respectively). However, an antero-posterior increase in the size of the mandibular corpus was most apparent in the incisor alveolus region (approximately 35 per cent increase in size). For shape-change, the Korean and European-American mandibular configurations were fairly isotropic except in the symphyseal and incisor alveolus regions. Dissimilarities in mandibular morphology are identifiable particularly in the dento-alveolar regions in subjects of diverse ethnic origin exhibiting Class III malocclusions. These differences may reflect genetic and/or environmental influences that might determine the severity and prevalence of the condition, and its subsequent clinical management.

Asian People↗

PubMed2000

Euclidean distance matrix analysis of surgical changes in prepubertal craniofacial microsomia patients treated with an inverted L osteotomy.

OBJECTIVES: Correction of craniofacial microsomia (CFM) presents several challenges concerning the modality of surgical intervention. The aim of this study was to assess early and late surgical outcome, by undertaking Euclidean distance matrix analysis (EDMA) of CFM patients exhibiting an unilateral mandibular deformity that was surgically corrected by an inverted L osteotomy and autogenous bone graft. DESIGN: Longitudinal study. Preoperative, approximately =1-year postoperative and approximately 3-year postoperative assessments of 14 consecutive children (mean age 9 years) with CFM. Posteroanterior cephalographs were scanned and five homologous mandibular landmarks were digitized in triplicate (< 1% digitization error). Average mandibular geometries, scaled to an equivalent size, were generated using a generalized rotational fit program (Procrustes superimposition) and subjected to EDMA. RESULTS: The mean pre- and both postoperative mandibular configurations differed statistically (p < .01). Early postoperative improvements in mandibular form were noted; increases in length arising in the treated mandibular body (approximately =19%) and ramus (approximately =13%). Comparing early and late postoperative configurations, a decrease of approximately =22% in the late postoperative mandibular body length was evident, but the ramus maintained steady vertical growth (approximately =7%). Comparing the preoperative and late postoperative configurations, the decrease observed in the mandibular body on the treated side was reduced to approximately =8% while the ramus maintained good growth (approximately =20%) on that side. CONCLUSION: Mandibular morphology is improved significantly in CFM patients surgically treated by an inverted L osteotomy, but relapse in the mandibular body is evident after approximately =3 years. Nevertheless, ramus growth proceeds well after the surgical reconstruction.

Adolescent↗