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At least 451 records · Page 25Linked to original sources

PubMed2000

Radiofrequency tissue volume reduction of the soft palate in simple snoring.

BACKGROUND: Snoring is common and often associated with social morbidity. Current therapies are generally unsatisfactory, but radiofrequency tissue volume reduction (RFTVR) palatoplasty offers a new approach. OBJECTIVE: To assess the outcomes and morbidity associated with RFTVR palatoplasty. DESIGN: Open, prospective trial. SETTING: Tertiary referral center. PATIENTS: 20 adults with loud habitual snoring without clinically significant obstructive sleep apnea. INTERVENTIONS: Three treatments with RFTVR to the middle, distal, and proximal thirds of the midline of the soft palate. MAIN OUTCOME MEASURES: Clinical assessment (visual analog scores) before and after each treatment, polysomnography (with sound intensity measurements), and lateral cephalometry performed prior to the first treatment and 2 months following the final treatments. RESULTS: After treatment, there was a significant overall improvement in the snoring visual analog score (7.5+/-1.5 to 4.6+/-2.5; P<.001), a small reduction in the proportion of sleep spent snoring at 50 to 60 dB (P = .03), and mild pain that was controlled with simple analgesia. There were no long-term adverse effects. Individual response could not be predicted by demographic, polysomnographic, or cephalometric data. Treatment of the proximal third of the soft palate was associated with fewer adverse effects but also seemed less effective than at the other sites. CONCLUSIONS: (1) The RFTVR palatoplasty is well tolerated with very low morbidity. (2) It is associated with subjective improvement in snoring in most patients. (3) Placement of lesions seems to influence outcome. (4) The improvement is accompanied by a marginal change in objective measurements, suggesting either an acoustic change independent of sound intensity or a placebo effect. (5) A randomized controlled trial is needed to further evaluate this therapy.

Adult↗

PubMed1994

The functional role of the tonsils in speech.

OBJECTIVE: To present illustrative cases showing various tonsillar influences on speech and to present a clinical method for patient evaluation establishing concepts of management and a rational therapeutic approach. DESIGN: The cases were selected from a group of approximately 1000 patients referred to the clinic because of suspected palatal diseases. Complete velopharyngeal assessment was made, including otolaryngologic, speech, and hearing examinations, polysomnography, nasendoscopy, multiview videofluoroscopy, and cephalometry. RESULTS: New observations further elucidate the intimate relation between the tonsils and the velopharyngeal valve. The potential influence of the tonsils on the velopharyngeal valve mechanism, in hindering or assisting speech, is described. CONCLUSIONS: In selected cases, the decision to perform tonsillectomy depends on its potential effect on speech. The combination of nasendoscopic and multiview videofluoroscopic studies of the mechanical properties of the tonsils during speech is required for patients who present with velopharyngeal insufficiency in whom tonsillar hypertrophy is found. These studies are also required in patients with palatal anomalies who are candidates for tonsillectomy.

Cephalometry↗

PubMed1997

Objective techniques for craniofacial assessment: what are the choices?

The approach to an individual with unusual facial appearance has traditionally involved a subjective assessment coupled with a few craniofacial measurements. Our ability to describe facial morphology has improved in recent years through the development of new techniques such as computerized tomography, magnetic resonance imaging, ultrasound studies, and stereoscopic imaging. However, the relatively simpler techniques of anthropometry, cephalometry, and photogrammetry, developed prior to the advent of microchips and imaging software, continue to provide unique advantages not afforded by these technically more sophisticated methods. These objective methods should enhance pattern recognition, particularly in rare syndromes, and allow for earlier diagnosis.

Anthropometry↗

PubMed1993

Quantitation of craniofacial anomalies in utero: fetal alcohol and Crouzon syndromes and thanatophoric dysplasia.

The study of fetal growth and development by ultrasound has been greatly facilitated in the past few years by the availability of anthropometric standards for the fetal body. Thus, the obstetrician is able to discern between normal and grossly abnormal, and even to quantitate certain fine fetal structures such as the face. This paper presents results obtained from a group of 5 patients referred to the Medical Center from private practices in Indianapolis, Indiana. Prenatal cephalometric analyses by ultrasound suggested the presence of craniofacial anomalies in all 5 cases. However, such defects were not detectable by routine ultrasonographic examination. A clinical examination after birth of each of these 5 patients suggested the following diagnoses: Fetal Alcohol Syndrome (FAS) in 2 individuals, Fetal Alcohol Effects (FAE) in one individual, Crouzon Syndrome (CS) in one patient, and Thanatophoric Dysplasia (TD) in one patient. In order to compare the craniofacial measurement values for each patient to normal standards, we developed Z-Score profiles and Pattern Variability Indexes (PVI) as described by Garn et al. [1984, 1985]. The values presented here support the idea that even mildly abnormal fetal craniofacial patterns are detectable by this relatively new application of ultrasound. At the present time, no conclusions can be made regarding the diagnostic accuracy of these patterns and profiles. However, the potential value of fetal cephalometry for documenting craniofacial dysmorphology is clearly indicated.

Cephalometry↗

PubMed1976

Physical anthropology and the dental and medical specialties.

The rise of two sub-specialties in Physical Antrhopology traces back to the Anatomy Departments of Schools of Medicine in Germany and France during the nineteenth century. The study of human diversity in bones and bodies was largely by medically-trained anatomists. There developed Medical Antropology and Dental Anthropology, employing osteometry and craniometry on the skeleton, somatometry and cephalometry on the living body. As a result cross-sectional studies gave way to longitudinal studies and X-ray techniques were added to purely mensurational procedures. In Medical Anthropology the specialties most directly concerned are pediatrics, plastic surgery, endocrinology, and orthopaedics. In Dental Anthropology the specialties most directly concerned are pedodontics, orthodontics, oral surgery, and prosthodontics. The contributions of Physical Anthropology to each is discussed.

Anthropology, Physical↗

PubMed1987

Studies on orthocephalization: growth behavior of the rat skull in the period 13-49 days as described by the finite element method.

Rat cranial skeletal growth was studied, using a cross-sectional data set, for the period 13-49 days by the application of the concepts of continuum mechanics and the numerical techniques of the finite element method (FEM). In contrast to the methods of conventional craniometry (CM) and roentgenographic cephalometry (RCM) the FEM permits fine scale, reference frame invariant descriptions and analysis of growth behavior. This advantage was demonstrated by a numerical example of the use of FEM. The skull was discretized into a number of two-dimensional, triangular elements, whose enclosed areas corresponded closely to both specific skeletal structures and to related functional matrices. Since it was assumed presently that the growth behavior of all of the points enclosed within a given element was similar, the application of the functional matrix hypothesis permitted an integrated description of the growth of the skeletal structure and functional matrix related to each element. The principal locus of rotation of the facial skull, relative to the cranial base, is the inferior frontoethmoidal articulation, a motion that includes a rigid body rotation. Other active and passive skeletal and visceral growth events associated with orthocephalization were located and described. Finally it was shown that the morphogenetically important growth behavior of other portions of the rat head were not directly involved in orthocephalization.

Aging↗

PubMed1989

Human occlusofacial form commonality: race-related traits, ontogeny, paedomorphism, and functional correlates.

Previous cephalometric studies of occlusofacial angular and metric data show small variability within and between population samples of Caucasian children and adults. Comparable results were obtained by use of standardized X-ray cephalometry and direct craniometric measurements of skulls of mature specimens of Alouatta caraya and Cebus capucinus. These data measure facial and occlusofacial form and form relationships. Identical measuring techniques are applied to compare data derived from headplates of 19 young adult American Caucasians and 19 articulated Hindu skulls of mature individuals. The data are expanded to include measurements that relate symphyseal form to occlusal and nasomaxillary structure. The facial plane and an "internal" facial plane (nasion to a point tangential to the superior genial tubercles) straddle the mandibular symphysis. The angles they form at nasion and at their intersections with the maxillary occlusal plane were derived and statistically analyzed. The occlusal plane intersect angles show small absolute variability and are not significantly different (P greater than .05) in the two groups. The nasion plane angles are significantly different (P less than .025), reflecting sample differences in facial height. Linear measurements confirm a considerably larger dentoalveolar prognathism in the Hindu group. Data derived from the geometrically averaged tracings of Bjork, Broadbent, Sassouni, and Solow provide further evidence of occlusofacial form commonality. These shared phyletically conservative traits are evidence of highly integrated morphological adaptations for the attainment, maintenance, and functioning of the species-wide pattern of precisely fitting complementary crowns and crown parts that constitute the dental occlusion.

Adolescent↗

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↗

PubMedDate not supplied

Biparietal diameter and menstrual age in the black population attending Edendale Hospital.

The relationship between fetal biparietal diameter measured by echography and menstrual age for blacks was studied. Predicted values and their confidence limits are presented in tables and graphs. The biparietal diameter was significantly smaller from 28 weeks than American and European studies, demonstrating that a composite graph was not applicable to the Zulus. The echographic results were checked at term by external cephalometry. Occipitofrontal circumference and birth weights for newborns were found similar to other studies. The smaller BPD in late pregnancy could be explained by the head's shape. The new charts are valuable in assessing fetal growth in African blacks.

Birth Weight↗

PubMed1990

Extrinsic fetal akinesia and skeletal development: a study in oligohydramnios sequence.

Long-bone morphometry and cephalometry were performed in 13 newborns with oligohydramnios sequence (OS) in order to establish whether or not skeletal changes existed in extrinsic fetal akinesia similar to those observed in the fetal akinesia deformative sequence (FADS) (i.e., hypoplastic long bones and micrognathia). Oligohydramnios sequence was caused by bilateral renal agenesis in five cases and obstructive uropathy in eight cases. Twenty-one stillborns and newborns who had died from conditions other than renal anomalies or congenital malformations were used as controls. Normal longitudinal and periosteal long-bone growth and absence of micrognathia were found in OS patients. Skeletal differences between FADS and OS may be explained not only by timing, duration, and degree of reduced motility but also, and more importantly, by the normal muscular stress in OS patients.

Amniotic Fluid↗

PubMed1989

Cyclosporine induces abnormal facial bone growth in children: a preliminary study.

Using cephalometric radiography, facial bony structure of a group of pediatric renal transplant recipients immunosuppressed with cyclosporine (CsA) and prednisone was studied and compared with a control group of children. A pattern of abnormal facial growth was demonstrated on cephalometry in eight of nine transplant recipients receiving CsA. The abnormalities included shortening of posterior facial height and increased anterior facial height with a deep mandibular plane angle. There was also an absolute shortening in the mandibular body and mandibular retrognathia. These findings may be consistent with inhibition of mandibular condylar growth inhibiting the anteroinferior growth of the mandible. Similar changes were present in two children with end-stage renal disease and none of the remaining nine control patients (P less than 0.01, chi-squared analysis). The affected area appears to be the lower third of the face. The role of CsA in affecting facial bony growth in children needs to be evaluated further.

Adolescent↗

PubMed1999

Evaluation of labio-lingual bony support of lower incisors in orthodontically untreated adults with the help of computed tomography.

The aim of the present study was to assess bone volume and bone density in orthodontically untreated adults using a CT analyzing method, with reference data in the clinically essential area of the lower incisors being obtained. For quantitative and qualitative assessment of the labial and lingual bony support of the lower incisors, existing CT-images of 20 adult men with a near-to-normal occlusion and a clinically healthy periodontal situation were evaluated. With the help of a special program (SIM/Plant) and on the basis of axial scans, sagittal scans were constructed, permitting the individual imaging of the lower incisors and their alveolar process. The bony support of each tooth was registered labially and lingually perpendicular to the tooth axis at intervals corresponding to 10% of the root length. At the various root levels, especially at the upper parts of the roots, only small amounts of bony support, if any, were frequently observed. Labially, bony fenestrations and dehiscences were frequently seen, but lingually mostly dehiscences. No clinically relevant association was found between labial bony support and cephalometrically registered inclination of the lower incisors. Bone density, which was registered in Hounsfield units at the gingival, middle and apical thirds of the root levels, increased from the gingival to the apical thirds of the roots, generally with lower lingual than labial values. Before initiating orthodontic treatment a thorough clinical assessment of the anatomical situation in the lower incisor segment should be carried out. At present bone volume in this area can be reliably assessed only with computed tomography; however, this has to be weighed up against increased radiation risks. Therefore, the form of the symphysis should initially be roughly assessed by means of conventional cephalometry, with additional CT-based analysis of individual teeth being confined to special indications.

Adult↗

PubMed1991

[Comparative study of the accuracy of localizing cephalometric reference points in using digital and conventional imaging technique].

The purpose of this study was to present possible advantages of digital luminescence radiography for cephalometry. Conventional and digitalized lateral headfilms were compared and evaluated. The first impression of an improved simultaneous presentation of bony structures and soft tissue profile in digital x-rays was statistically verified. A significant difference in identification of several reference points was proven by means of the F-test. The superior results of the digital luminescence radiography were evaluated in comparison with xeroradiography and experimental postdigitalization of conventional x-rays.

Cephalometry↗

PubMed1989

[Reproducibility of rhinomanometric measurements of nose breathing resistance and of x-ray cephalometric recordings of the natural head position in children].

The reproducibility of rhinomanometric recordings of nasal resistance to breathing and of cephalometric recordings of natural head position was studied in 30 children aged seven to 13 years. Posterior rhinomanometry, with and without decongestion of the nasal mucosa, was performed on two occasions. Rhinomanometric registration was possible in 92% of the children but the recorded values for air flow showed a considerable intraindividual variation. The natural standing position of the head and of the cervical spine as well as the relation between the head and the cervical spine was recorded in profile by X-ray cephalometry on two occasions. During the recording, the subject was looking at his face in a mirror. Systematic differences between the duplicate determinations and an accidental error of 4 degrees in the determination of the position of the head and the cervical spine were found. In about 10% of the cases, the differences between the duplicate determinations were greater than 10 degrees.

Airway Resistance↗

PubMed2001

The influence of cephalometric parameters on resonance of speech in cleft lip and palate patients. An interdisciplinary study.

There are only few studies concerning the correlation between craniofacial morphology and resonance of speech in cleft palate patients. Moreover, these investigations show a considerable inhomogeneity in material and method, their basic approach was predominantly retrospective, and the statistical methods were restricted to univariate procedures. Thus, the aim of the present study was twofold: firstly to clarify the extent to which correlations exist between craniofacial morphology and resonance of speech in cleft palate patients, subject to a sufficiently large number of patients being available to ensure differentiation with regard to age and cleft type, and secondly, within a prospective longitudinal study in juvenile cleft palate patients, to investigate whether pubertal craniofacial growth changes result in changes of resonance. The collective comprised 137 cleft palate patients. The following investigations were performed: lateral cephalometry, nasometry, and standardized speech recording. Additionally, these investigations were repeated in 51 juvenile patients after a minimum time interval of 2 years. In order to analyze the complex relations between craniofacial morphology and degree of hypernasality, multivariate statistical procedures were applied. The results of the present study indicate complex correlations between cephalometric parameters and resonance of speech, requiring age-specific differentiation. In this regard, the ratios between the length of the soft palate and the sagittal depth of the nasopharyngeal airway were of prime importance. Beyond this, significant correlations were found between craniofacial growth changes and changes of resonance during puberty which might be influenced both by dentofacial orthopedics and by maxillofacial surgery.

Adolescent↗

PubMed2003

The comparison of reliabilities in dental imaging methods.

OBJECTIVES: Common practice in the statistical comparison of imaging instruments with limited reproducibility consists in the separate estimation of the instrument's reliabilities. However, as soon as one of the imaging methods is subject to item-specific bias (which has to be expected in many dentomaxillofacial imaging procedures), this approach will end in severe errors in reliability computation and in corresponding erroneous clinical conclusions. This paper seeks to point out these effects and to illustrate a more appropriate model for the comparison of instrumental reliabilities. METHODS: A standard reliability model was adjusted for item-specific bias and illustrated by the comparison of twice repeated planimetric cephalometry versus twice repeated noninvasive orthodontic video imaging (based on the Digigraph 100 device) in 50 children; the anterior cranial base length was used for illustration. RESULTS: The proposed model revealed pronounced inferiority of the video-based imaging system concerning its reliability compared with the X-ray based standard. Analysis using separate estimation of the two reliabilities would result in the reverse conclusion and thus falsely establish video imaging, which is in fact less reliable, as a superior diagnostic method. CONCLUSION: The reliabilities of dentomaxillofacial imaging methods have to be adjusted for potential item-specific bias to avoid the erroneous conclusion of the superiority of a diagnostic innovation.

Adolescent↗

PubMed2005

Potential and limitations of cephalometric analysis of maxillofacial bone movement in the case of LeFort III-distraction.

BACKGROUND AND METHOD: The treatment of craniofacial deformities by means of distraction osteogenesis has become an established therapeutic procedure. Evaluation of the success of an operation is usually carried out via conventional cephalometry. Conventional forms of analysis seem problematic due to surgically-induced changes in the skull base. In this study we investigated the movement of the midface in the presence of a syndromerelated surgical indication employing two different types of analysis, namely those of Ricketts and Delaire. RESULTS: It seems that neither procedure is suitable for determining this type of bone movement conclusively. Comparing the two, the Delaire analysis possessed greater informative value in view of the altered geometry, and a combination of both procedures made more exact determination possible of the final position achieved.

Adolescent↗

PubMed2004

[Genioplasty alone and in combination. Long-term results with emphasis on sensitivity and photoanalysis].

PURPOSE: Striving for beauty and expressiveness is a deeply rooted human attitude. The lower jaw-especially the mentum-plays an important role in the perception of the face as an instrument of communication. According to Grammer a distinctive lower jaw is an essential characteristic feature of male attractiveness. MATERIAL AND METHODS: During a period of 10 years 58 patients underwent genioplasty. A follow-up examination was performed in 49 patients (complete sensitivity evaluation: 33 patients, complete photoanalysis: 30 patients). To reduce radiation due to cephalometric radiography a simple photometric method for cephalometry was developed and applied. Particular attention was directed at sensitivity of the mental nerve after genioplasty. RESULTS: To the best of our knowledge, this is the first time that photos of the right profile were compared with those of the left side. Unexpectedly, intraindividual differences dependent on the facial side (right and left) could be found in the relationship of the lower to the upper face and in the proportion of the profile angle and the nasomental angle. After three-dimensional genioplasty these differences were reduced and facial asymmetry was improved. Comparing the right with the left side the average difference of the nasomental angle was reduced from 2.5 degrees to 0.6 degrees on average. The profile angle was changed by genioplasty from 19 degrees on average to 15 degrees ("ideally" 10 degrees , the so-called upright face). According to Schwarz the ideal height of the mentum (stomion-menton) should amount to 66% of the total lower face. Especially by combined dorsal and cranial positioning of the mentum a reduction from 85 to 68% was achieved. Postoperatively 24 of 33 patients (73%) showed disturbances of the mental nerve. After at least 1 year following the operation, normal sensitivity of the lower lip and chin of both sides was evaluated by almost all of these patients (19 of 24 = 79%). Especially all patients having had only a single genioplasty recovered totally from a neurosensory deficit. CONCLUSIONS: Genioplasty can be considered to be a reliable procedure to achieve harmony of the lower face.

Adolescent↗