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Biomedical subjects

Z Müllerová

Publications and source records attributed to Z Müllerová.

At least 19 recordsLinked to original sources
PubMed2005

Midface distraction in patients with cleft palate.

Cleft palate patients with a severe maxillary hypoplasia can pose a very challenging problem for the surgeon. Traditional orthodontic surgery methods frequently do not fulfil expectations from the point of view of achieving normal aesthetic proportions of the face. Therefore distraction is nowadays an important technique in the treatment of craniofacial skeletal dysplasias. To treat maxillary hypoplasia, either intraoral midface distractor IMD or rigid external distractor RED can be used. This study presents 16 patients. In five of them, we used the IMD and in 11 of them the RED. In all of the patients we achieved good functional as well as aesthetic results. While using this method, complications were minimal. In this study, we analyse surgical and orthodontic methods as well as the advantages and disadvantages of both surgical methods.

Adolescent↗
PubMed2005

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.

Adolescent↗
PubMed2005

Long-term stability of prosthetic treatment of oronasal and oroantral communications.

This five-year prospective study demonstrates prosthetic treatment by multidisciplinary therapy: surgeon, orthodontist, and prosthodontist. 10 patients volunteered for the study (a group of 7 men and 3 women at an average age of 33.2 years). 10 obturators, 49 fixed dentures were inserted to the upper jaw. Based on ADA (American Dental Association) recommendation a special card was prepared containing relevant information on the patients. Clinical assessments were carried out in accordance with the US Public Health Service System. In a 5-year period only 50.0% of restorations were excellent, receiving 100% alpha rating. The marginal ridge contour and adaptation of obturator achieved 60.0% alpha rating. The anatomic form of dental arch was destroyed in 50.0%. The presence of caries was not detected. Six teeth were extracted due to periodontal disease. The general contour of the restoration followed the overall contour of the fixed denture in 95.9%. Plaque accumulation was found in 50%. The colour match of crowns was darker and translucent in 27.7%, but discoloration of removable denture was seen in 30.0%. The three case reports demonstrate the long-term stability of treatment (from alpha to charlie evaluation). Attachment retention, fixed and removable denture with metal base are the first method of choice, due to acceptable long-term stability.

Adult↗
PubMed2004

The development of intracranial relations in patients with complete unilateral cleft lip and palate in relation to surgery method and gender aspect.

This study focuses on cranium development during puberty growth spurt in patients with complete unilateral cleft of the lip and palate (UCLPc) after use of various surgery methods. Next, this study focuses on cranium development differences between the genders in patients undergoing operations by the same method, as well as comparison of intracranial relations between impaired and healthy individuals. The work is based on longitudinal cephalometric measurement of X-ray films and it is interpreted by cluster analysis. It focuses mainly on mutual interrelations of linear dimensions (meaning longitudinal and vertical) with angular dimensions (characteristic of shape and position). Mutual relationships of linear characteristics were closer than its relationship with the angular characteristics and characteristics of shape and position were mutually closely related than with characteristics of the size. The development of the cranial shape in regards to the linear dimensions is influenced particularly by the depth of maxilla, the length of the ramus of the mandible, and the height of the upper face. The study confirms the least positive development of cranium in boys with a bone graft. Girls undergoing operations with the same technique have the advantage of earlier growth termination of most parts of the cranium, which makes it possible to maintain the results of the therapeutical compensation of the defect.

Adolescent↗
PubMed2003

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).

Adolescent↗
PubMed2001

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.

Cleft Lip↗
PubMed2001

Development of intracranial relations in patients aged 10 to 18 years with clefts of the lip and palate, using cluster analysis.

The investigation is based on a longitudinal cephalometric investigation of lateral teleroentgenographic pictures of male patients with a complete unilateral cleft of the lip and palate. Using cluster analysis the authors investigated the relationship of 75 craniofacial characteristics of size, shape and position during the time interval from 10 to 18 years of age. The main objective of the work was to characterize the development of intracranial relations during the pubertal spurt and compare the final condition in adulthood with a control group. The angle of the cranial base and its effect on the position of the mandibular joint did not change during the investigation period. The relationship between the rotation of the mandible and the inclination of the upper alveolar process with the protrusion of different parts of the skeletal profile also remained constant. Up to adulthood, the rotation of the mandible developed independently of the sagittal intermaxillary relations. The relationship between the sagittal intermaxillary relations and other parts of the face did, however, change. Before the onset of puberty it was influenced most by the reduced length of the maxilla. The inadequacy of maxillary growth was balanced during this period by a change in the shape and position of the mandible. Its adaptative capacities could not compensate later for this uneven development of the jaws potentiated by the pubertal growth spurt. Due to this the intermaxillary relations deteriorated at the end of development in the majority of patients. The association of the restricted vertical maxillary growth with its retroposition was manifested only in adulthood. Intracranial relations of the control group differed from those in the group with clefts. Sagittal intermaxillary and dental relations were not associated in healthy men. As individual probands were not linked by any restriction of growth or development, no close relationship developed between the shape characteristics of the lower jaw, which is the main compensatory adaptative mechanism.

Adolescent↗
PubMed2000

Interdisciplinary collaboration in cleft problems: surgeon-stomatologist.

During treatment of patients with clefts, reliable interdisciplinary collaboration of plastic surgeons and stomatologists-orthodontists is essential. The authors describe the principles and procedures of these disciplines that are linked and mutually interconnected. These have been elaborated on the basis of many years experience and have proven very satisfactory in the long-term care of patients.

Adolescent↗
PubMed1999

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.

Adolescent↗
PubMed1999

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.

Adult↗
PubMed1997

Changes of craniofacial growth and development in males with complete unilateral cleft lip and palate between the age of 5 to 20 years.

The study is based on an anthropometric assessment of X-ray films obtained in two series of males with complete unilateral cleft lip and palate. The first series was examined at the age of 5, 10 and 15 years, the second series at 15 and 20 years. The films were assessed with Jarabak's analysis. The aim of our study was to compare the amount of growth and character of developmental changes in the prepubertal, pubertal and postpubertal period of life. The highest growth rate of skeletal structures was present in the prepubertal period, it was somewhat slighter in the pubertal period and it still continued in the postpubertal period. The high growth rate in the prepubertal period was probably related to the eruption of permanent teeth. In spite of a marked deterioration of sagittal jaw relations during the prepubertal period an improvement of an overjet was attained. However during the puberty and the postpubertal period a further improvement was not recorded. The results are in agreement with facial type of growth characterized by a slight pubertal spurt.

Adolescent↗
PubMed1997

Deviations in craniofacial morphology in patients with complete unilateral cleft lip and palate evaluated by Jarabak's analysis.

The study is based on evaluation of X-ray films of the head of 29 boys aged 5 years and 34 males aged about 20 years with complete unilateral cleft of the lip and palate. Deviations in the craniofacial morphology were assessed using the Jarabak's analysis. Most linear dimensions were smaller in both children and adult patients. The exception was the posterior part of the cranial base the length of which was the same as in controls. The anterior part of the cranial base and the mandibular body were significantly shortened only in 5-year-old individuals while the maxillary body was shortened only in adult patients. The anterior facial height was elongated in adult patients. The mandible showed a posterior rotation, the gonial angle was increased in its lower part. The maxilla and mandible were retrusive with impaired vertical--and in adults also sagittal--jaw relations. Both upper and lower incisors showed retroinclination. In 5-year-old patients an anterior crossbite developed, a trend to open bite was evident in adult patients. The upper lip was retrusive while the lower lip was protrusive. Jarabak's method is not sufficient for an accurate analysis of the soft profile in patients with clefts.

Adult↗
PubMed1996

Position of upper permanent central incisors prior to eruption in unilateral cleft lip and palate.

The position and degree of eruption of permanent central incisors within the premaxilla were measured on x-ray films obtained in 102 patients with unilateral cleft lip and palate and in 52 normal individuals aged 5 years. The patients were subdivided according to sex and to the method of surgical repair (bone grafting or periosteal flap surgery). Individuals with rotated incisors were assessed separately. The results showed that maxillary depth was not significantly reduced prior to palate surgery while the alveolar process was markedly retroclined. An unerupted central upper incisor on the side of the cleft was situated more anteriorly than in controls. Because of the distortion of the alveolar process, it was retroclined and produced a deformation of the subspinal concavity. Both this deformation and the distortion of the alveolar process interfered with the measurements of maxillary depth and rendered it inadequate. The incisor on the normal side was situated more posteriorly than in controls and was less retroclined than the incisor on the affected side. The degree of eruption of incisors on both the normal and affected sides did not differ from controls. The type of surgical repair influenced only the retroclination of the alveolar process and of the incisors within this process. The retroclination was more marked after primary bone grafting than after periosteal flap surgery. The position and degree of eruption of rotated incisors did not differ from nonrotated incisors, and the presence of rotated incisors was not related to the degree of the shortening of maxillary depth. There were no significant differences between males and females.

Bone Transplantation↗
PubMed1996

Facial development in unilateral cleft lip and palate prior to the eruption of permanent incisors after primary bone grafting and periosteal flap surgery.

Roentgencephalometric studies were carried out at the age of five years in 27 boys with unilateral cleft lip and palate after primary bone grafting, as well as in 25 boys with the same type of cleft after primary periosteoplasty and in 27 normal boys who served as a group of controls. Both series with clefts differed from the group of controls by a reduced upper face height, maxillary dentoalveolar retroinclination, posterior position of the maxilla and by the shortening of mandibular body and ramus. There was a slight reduction of maxillary depth only in the series with bone grafts. The other skeletal deviations were secondary. The soft profile showed in both series with clefts a reduction of the upper lip height and of the nasal prominence. In patients with bone grafts was recorded in addition a reduced prominence of the upper lip. A comparison of both series with clefts disclosed that primary bone grafting reduced the vertical growth of the upper face and increased the dentoalveolar retroinclination of the maxilla resulting in a larger impairment of overjet and in a more marked retrocheilia. A better prominence of the nose in the series with periosteal flap surgery was produced by the primary reposition of the nasal septum, which was not performed during osteoplasty.

Bone Transplantation↗
PubMed1996

Dental care in patients with facial clefts.

The dental care in patients with facial clefts is discussed. In addition to the routine dental care these patients should be submitted to a long-term complex orthodontic therapy and in some of them is required a prosthesis or dental surgery.

Child↗
PubMed1995

Craniofacial growth and development in unilateral cleft lip and palate: clinical implications (a review).

The main problem of facial development in cleft palate consists of deficient anterior growth of the upper jaw. Roentgencephalometric data showed that the sagittal jaw relations deteriorated gradually from palate surgery up to adulthood. In spite of this adverse trend of growth, orthodontic therapy succeeded in improving the occlusion of incisors during prepubertal period. However during the pubertal growth spurt occurred an impairment of occlusion which was caused by the depletion of compensatory dentoalveolar mechanisms of the jaws due to the previous orthodontic treatment. An effective compensation of the gradual impairment of sagittal jaw relations can be attained with fixed appliances. These observations showed that the main problems of facial growth in clefts developed only after palate surgery and in particular during puberty. For favourable sagittal jaw relations and the configuration of the facial profile is of paramount importance the restoration of a positive overjet which exerts marked effects on the position of the mandible. On the other hand the configuration of the facial profile and the results of orthodontic therapy are affected by the rotation of the lower jaw and the amount of posterior displacement of the TM joint, which represent inborn growth patterns of the skull. The most favourable developmental situation represents the posterior displacement of the TM joint associated with neutral type of rotation. Therefore, it is of importance to predict the development of these characteristics.

Adolescent↗
PubMed1994

Development of overjet and dentoskeletal relations in unilateral cleft lip and palate before and during puberty.

Roentgencephalometry was used for the assessment of the development of clinically important facial characteristics in complete unilateral cleft lip and palate during the prepubertal and pubertal period. Thirty-one patients aged 8 and 11 years and 30 patients aged 11 and 14 years were examined repeatedly. All of them were operated upon and orthodontically treated with the same methods. An unfavorable development of facial convexity, sagittal jaw relations, configuration of the soft profile, and of the prominence of the upper lip occurred during both periods. An improvement of overjet that was attained during the prepubertal period showed a renewed impairment during the period of puberty. The impairment was not caused by the higher facial growth rate, but was attributable to the exhaustion of the compensation and adaptation mechanisms of the dentoalveolar component of the upper jaw produced by the preceding orthodontic therapy. The development of sagittal jaw relations and of facial rotation was not related to the initial patterns of these characteristics, but the possibility of an improvement of the inclination of upper incisors and of overjet was influenced by their initial pattern. During the prepubertal period the development of overjet was not related to the development of sagittal jaw relations or of mandibular growth rotation, as was the case during puberty.

Adolescent↗