Biomedical subjects
Publications and source records attributed to H P Freihofer.
Case report of conventional palatal soft-tissue expansion in an attempt at cleft palate fistula closure with a standard tissue expander. This technique may be an alternative to a tongue flap to promote closure of persistent oronasal fistula.
Recent animal experiments have shown that palatal repair without denudation of bone leads to a superior dento-alveolar development. The aim of this clinical study was to evaluate the peri- and postoperative course and the dento-alveolar development of the deciduous dentition in Japanese ULCP, and CP patients up to 5 years after two different types of palatal repair. One of the methods, the Kohama (1991) supraperiosteal flap technique, is performed without denudation of the bony palate, while the other, the Wardill (1937) push-back technique, results in areas of denuded bone. It was concluded that the supraperiosteal technique can be performed successfully in approximately the same amount of time as the push-back technique. Re-epithelialization of the wound areas after supraperiosteal repair takes about 1 week, which is one third of the time associated with healing after the push-back technique. Arch depth of the deciduous dentition after the supraperiosteal technique is superior compared to the push-back technique. The question of whether or not the supraperiosteal technique produces more favorable dento-alveolar development than the mucoperiosteal technique in the permanent dentition in humans has to be elucidated in future research.
In this article an introduction into craniofacial surgery in children is given based on the case histories of two patients (cleido-cranial dysplasia and cranio-synostosis).
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The dental occlusion and alterations in orofacial muscles were studied in 267 patients whose severe anterior open bite had been treated with a Le Fort 1 intrusion osteotomy with or without an advancement sagittal split osteotomy about 6 years ago. Only 17% of those patients showed anterior contact, and 20% had no vertical overlap of mandibular and maxillary central incisors at all. Tongue position, activity of masticatory muscles, lip competence, lip-incisor relationship, and breathing mode were assessed. Statistically significant correlations were found between tongue positions and occlusion in both the anterior and the posterior regions. In addition, the activity of the masticatory muscles, habitual mouth posture, and interlabial distance were each significantly correlated to overbite, open bite, and overjet. The interlabial distance was also significantly correlated with both breathing mode and mentalis muscle activity. The activity of the masticatory muscles was negatively correlated with tongue position.
The present study compared the dentoalveolar development in beagle dogs after palatal repair according to the partially split flap technique and the von Langenbeck method. It was concluded that palatal surgery according to the partially split flap technique resulted in significantly wider transverse distances of the maxillary dental arch than after the von Langenbeck procedure and that its final outcome closely resembled that of the control group.
To assess the aesthetic and functional results of primary treatment of telecanthus in patients with naso-orbito-ethmoidal fractures, the results in 36 patients were evaluated in a retrospective study. Twenty had double-sided telecanthus: 13 required an indirect technique of canthopexy and seven a direct technique. Sixteen had unilateral telecanthus, of whom six were treated by the indirect and 10 by the direct technique. The intercanthal distance (ICD) was measured directly postoperatively and more than 12 months after reconstruction. The late ICD after application of the direct technique was nearly 3 mm smaller (ANOVA, P < or = 0.02, mean 34.3 mm) and yielded 2 mm less relapse (ANOVA, P < or = 0.02) as compared with the indirect technique. Delayed or late-primary treatment showed a significantly higher frequency of epiphora (chi-square test, P < or = 0.05). Early primary treatment of traumatic telecanthus produced the best aesthetic and functional result.
The case of a 35-year-old woman with a history of several temporomandibular joint (TMJ) operations, including condylectomy, is reported. She presented with myofacial pain and partial fibrous ankylosis of her right TMJ. The ankylosis was released and an autogenous costochondral graft was used to restore the vertical dimension of the ramus. About 3 months after surgery, a fracture of the graft occurred during physical therapy. The cause of this complication is discussed with reference to the literature.
In a 12-year period, 56 consecutive patients have undergone secondary periorbital reconstruction after trauma. To evaluate the overall results and the need for further correction, three diagnostic groups were formed. These were: malar bone (n = 16), midface (n = 16) and fronto-orbital fractures (n = 24). Also, in order to judge the reliability of the procedures used most frequently, all osteotomies of the zygoma (n = 32 in 30 patients), canthopexies (n = 26 in 19 patients) and corrections of the bony nasal skeleton (n = 26) were assessed as separate groups. After malar fractures, poor results were found in two cases while after midface fractures the results were quite satisfactory with only one poor result. The outcome after fronto-orbital fractures was also generally satisfactory. However, after a considerable number of later corrections there were still four poor results. Unfortunately, osteotomy of the zygoma left a rather high percentage of unsatisfactory results (19%), but canthopexies scored high and further corrections after secondary surgery of the nasal skeleton eliminated all but one poor result. It is concluded that 7% of our trauma patients undergo secondary and further periorbital corrections. The techniques have become routine. The final outcome was assessed as good in 60% and poor in 20% of patients.
Three patients are presented in whom retropositioning of the anterior upper teeth resulted in accelerated aging of the face. Two basically different approaches to correct these bad results are illustrated. It is shown that onlaying of the maxillary base is insufficient but can be the only solution possible. Reversing the primary procedure seems much more effective. The technique, however, can be very demanding.
In earlier days segmental osteotomies had a broad field of indications. In the era of combined surgical-orthodontic treatments, they are pushed far into the background. This article shows that this development is unjust. If carefully indicated, segmental osteotomies still have a well-defined place in our armory of surgical interventions. With their elegance and the compulsion to respect detail they are not only of marked didactic value, but they also fill a gap, especially in the treatment options for the lower jaw. Far from being obsolete, they should still belong to the routine options when orthognathic surgery is considered.
A concensus conference on the timing of facial osteotomies was held in Jönköping, Sweden. Seven teams consisting of a maxillofacial surgeon and an orthodontist representing five countries discussed treatment planning for young patients with maxillomandibular deformities with special emphasis on timing. Patients with severe syndromic facial deformities were not considered. Consensus was reached that for most deformities it is best advised to wait until growth has ceased, as determined by longitudinal cephalometric data. This rule is less tight for Angle Class II than for Class III cases. For asymmetries often there is still not enough scientific evidence to obtain well-founded uniform agreement.
Palatal soft-tissue expansion might be appropriate for use in cleft palate surgery. Seventy-five cats were divided into four different experimental groups and one control group. Intraoral tissue expansion was started at the age of 14 weeks in normal or scarred mucoperiosteum. The experiment lasted until 24 weeks of age. Serial standardized lateral cephalograms from each animal were digitized, and the results were statistically analyzed. The results indicate that the effects are independent of the presence of scarred tissue, that sagittal growth is impaired by tissue expansion, and that the tissue expander induced resorption of palatal bone.
Our experience with third molar autotransplants in 2 patients, into an area irradiated at an early age, is described and discussed. It is shown that such autotransplantations are possible.
In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nijmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated in the Cleft Lip and Palate Center of the University Hospital of Nijmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nijmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined in the Nijmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nijmegen and Oslo. The profiles of the BCLP patients are more convex in Nijmegen and more concave in Oslo than in the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nijmegen and Oslo are compared and discussed in terms of their long-term results.
A patient undergoing orthognathic surgery wants to know in advance what he will look like after the treatment. For this purpose a prediction tracing may be used. The value i.e. precision of such a tracing is discussed. Several factors seem to limit the reliability of the prediction, such as 1. the surgery is not always executed as planned; 2. a (partial) relapse influences the final result; 3. rotational movements cannot yet be integrated with precision in the prognosis; 4. the ratios used in the planning are not absolutely reliable. Nevertheless, the prediction tracing is useful if one is aware of its shortcomings.
Corrective surgery after primary treatment of periorbital trauma is indicated for functional as well as aesthetical reasons. These indications and the over-all results will be discussed, based on 56 cases. Surgical techniques such as osteotomy of the malar bone or correction of the nose will be presented. It is concluded that 60% of the cases achieve a good, final result. In another 30% considerable improvements have been realized.
Over a 12 year period 56 patients presented for secondary corrections of the periorbital region after trauma. Corrections after isolated fracture of the zygoma improved the final result in 75% of the cases. Further correction seems useless. After midface fractures 85% became acceptable or good results. Tertiary corrections are usefull. The results after front-basal fractures were comparable. Twenty percent of the secondary canthopexies had to be revised once more. The final result was at least acceptable in all cases. Not all secondary nose-corrections lead directly to success, however, after further corrections only 5 percent remained unacceptable. Finally, overall good results were established in 60 percent and in another 20 percent at least an acceptable result could be reached.