[Dento-maxillofacial radiology: developments for the dental practice].
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A revised method of conservative palatoplasty was performed on 21 patients with isolated cleft palate. The operation was principally based on von Langenbeck's method. The major modifications were that the mucosal layer was dissected instead of the mucoperiosteum and lateral mucosal deficits produced by medial displacement of the dissected mucosal flaps were covered with transpositioned buccal mucosal flaps. Postoperative early results were compared with those of the 23 patients treated by Perko's mucosal flap operation. Our method was found to bring about a relatively long velum comparable to Perko's method and wound healing was more uneventful. Results at the age of 5 years were compared with those of the patients treated by Wardill's mucoperiosteal flap operation as well as with those treated by Perko's method. There were no statistically significant differences among the three groups in the maxillofacial development and speech results.
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The appearance of results of injury to the columella, the nasal septum, and the nasal bones, in particular, has been well described. Anomalies of the maxilla and global facial balance secondary to nasomaxillary injury are less well known. Three cases involving children, aged 11, 14, and 17 years, who had suffered nasomaxillary injury at least 8 years earlier as a result of physical beating, were studied with the use of photographs and architectural craniofacial lateral cephalometric radiographic analysis. The architectural craniofacial analysis of Delaire produced a graphic representation of the resultant maxillofacial deformities rather than a description of the deformities in terms of deviation from a statistical mean. Traumatic injury to the nasomaxillary complex provides an experimental model that implicates the role of the cartilaginous nasal septum and local functional conditions in the growth of the nasomaxillary complex. The importance of the functional premaxillary skeletal unit in balanced facial growth allows better understanding of the pathophysiology of malformation of this region.
Possible detrimental effects of palate repair on dentomaxillary growth have been reported before. In our study, two principally different surgical techniques were compared. Dogs with artificially created clefts of the palate were subjected to either a periosteal flap (Langenbeck) or to a bone flap (Dieffenbach) closure. Skull roentgenograms and upper jaw impressions were used to study the possible effects on growth. Definite abnormalities were found following both procedures; there are strong indications that the bone flap is the more detrimental one.
The protected childhood environment and the anatomy of the craniofacial skeleton largely protect children from experiencing facial fractures. However, when major trauma to the head and face is sustained, an oblique pattern of fractures has been observed, distinct from those common in adults and explicable in terms of the anatomic differences between the child's and the adult's head and face. This difference in pattern of facial fracturing is relevant in terms of the examination, investigation and treatment of the primary injury, and prevention of any subsequent facial growth disturbances.
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OBJECTIVE: To detect and analyze the correlation between commonly mutated genes and known genes associated with tooth agenesis in patients with non-syndromic tooth agenesis. The aim is to explore new genes that may be associated with tooth agenesis, to provide a genetic reference for its prevention as well as for the clinical diagnosis and treatment of tooth agenesis. METHODS: Genomic DNA was extracted from the peripheral blood of 18 congenitally edentulous subjects, and related gene mutations were identified by whole-exome sequencing. The genes related to maxillofacial development and the known pathogenic gene sequences of congenital tooth agenesis were selected for local alignment analysis of pairwise sequences, and the metric relationship of related sequences was determined. Hierarchical and fuzzy clustering methods were used for cluster analysis. RESULTS: Hierarchical clustering and fuzzy clusterings yielded consistent results. The EPB41L4A gene clustered with a large number of well-known and well-defined genes associated with tooth agenesis. From the perspective of cluster analysis, it can be inferred that the genes clustered together generally have similar functions. CONCLUSION: EPB41L4A, which is involved in the Wnt pathway, may be a candidate gene warranting further investigation.
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It is not possible to group the facial asymmetries in one single nosological entity. However, whatever the origin of these malformations, their surgical treatment is governed by the same principles. In this article, the author attempts to define certain aetiologies:genetic, congenital and developmental, of the minor assymmetries of the face. He then reviews the different techniques in current use, in plastic and reconstructive surgery:autogenic or homogenic tissue grafts (bone, cartilage, derm, fascia, etc.), implants of plastic material, osteotomies. He stresses the use of simple techniques which cause little mutilation, as well as the simultaneous correction of the profile which greatly enhances the aesthetic appearance and the psychological well-being of these patients.
A case of post-traumatic temporomandibular joint ankylosis is described, and the technique of the treatment is detailed. Previous review of the literature was made in order to know the advantages of the treatment. There are several reports of children who have suffered facial injuries and fractures of the facial bones that became into ankylosis, characterized by the formation of new temporomandibular joint surfaces. The patient was a five years old girl who presented ankylosis of TMJ due to a car accident six months before. The symptom were: Limitation of motion, persistent close lock of mouth (2 mm) muscle pain that causes the patient to avoid eating foods, and the gradual loose of phonetic function. Condylectomy of the left mandibular condyle was performed to correct the mechanical problems associated to ankylosis. The patient had an uncomplicated postoperative course, and now are waiting the outcome of the treatment by a follow up study.
A study of midfacial fractures in 28 children under 16 years of age treated at the Medical School Essen is reported. All children underwent surgical treatment. 18 patients with fractures of the zygomatic complex were treated by open reduction and miniplate osteosynthesis. 10 patients with blowout fractures were treated with "Lyodura"-implants. To prevent persistent diplopia an early surgical treatment is recommended. An adverse effect on the growth of facial bones has not been seen.
12 patients who had suffered mid face fractures during their childhood were examined for skeletal deformities of the facial skull. The cephalometric data showed that neither the position nor the inclination of the maxilla were significantly different from normal anatomy. No correlation was found between the age, the severity of injuries and surgical treatment and resulting deformities.
A number of cephalometric analyses are presently being used in the assessment of dentofacial deformities. These cephalometrics are mostly based on hard tissue assessment alone, although a few methods using soft tissue only or partially hard and partially soft tissues exist. Most of the analyses use angular and linear measurements, although some are based mainly on measurements of relationships. When the various cephalometric analyses are compared, considerable inconsistency comes to light; so much so, that cephalometrics sometimes cannot be considered as a primary diagnostic tool. A combination of two relationship analyses, one based on soft tissue assessment and one based on hard tissue assessment, incorporating the craniofacial complex, is presented to provide a higher degree of diagnostic accuracy. This combination analysis is based on only a few critical hard tissue landmarks of the cranial base that are used for the total assessment of the facial hard, dental, and soft tissues. This has eliminated inappropriate landmarks and lines that existed in each of the original analyses. The cephalophotometric and architectural-structural craniofacial analyses have been adjusted accordingly and renamed the profilocephalometric analysis.