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Internal fixation in pediatric maxillofacial fractures.

Pediatric facial trauma presents unique problems in diagnosis and management. The following review highlights relevant points of craniofacial growth and applied anatomy. The epidemiology of pediatric facial fractures is presented followed by pertinent features of clinical presentation and diagnosis. Management of midfacial injuries is discussed individually for each specific type of fracture with emphasis on the role of rigid fixation. Finally, the relationships between childhood fractures, rigid fixation and craniofacial growth are reviewed.

Child

Influences of different surgical procedures on growth of dentomaxillary complex in dogs with artificially created cleft palate.

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.

Animals

Dynamic cleft maxillary orthopedics and periosteoplasty: benefit or detriment?

In 1990, Drs Millard and Latham published their initial experience with dynamic maxillary appliances (DMAs) and periosteoplasty for children with cleft lip and palate. The technique provided for alveolar alignment and consolidation, with elimination of oronasal fistulas. Opponents to this approach speculated about impairments to facial growth. To date no longitudinal studies have been published. Over the last 10 years, 35 unilateral and 10 bilateral complete clefts have been treated with this technique. All patients have been followed and documented clinically, orthodontically, and radiographically. Cephalometric analyses were performed on children after the age of 6 years. The children have excellent facial aesthetics with well-balanced lips and noses. Radiographs demonstrate bone within the repaired alveolar clefts. Articulated impressions show anterior and lateral crossbites in the unilateral patients that improve over time and appear to be correctable orthodontically. The bilateral patients have satisfactory occlusions and arch forms. Cephalometric analyses confirmed no evidence of skeletal crossbites or midfacial growth retardation. This is a work in progress that will continue as the children grow. Although definite and final conclusions would be premature, it can be stated that to date all patients are following consistent and favorable growth patterns. Our team is confident in proceeding with this technique.

Alveoloplasty

Oblique craniofacial fractures in children.

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.

Accidents, Traffic

Whole exome sequencing and cluster analysis reveal that EPB41L4A mutation may trigger tooth agenesis.

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.

Humans

[Maxillofacial trauma in pediatric age].

The different incidence of various kinds of maxillofacial fractures in children are examined and the causes of such differences are analyzed. The most significant are the variations in morphology of the maxillofacial skeleton during the children's growth and the physical-statistic problems strictly connected. Attention is drawn on the diagnostic difficulties of traumas due to fractures during childhood, sometimes unknown, especially with regard to the heavy functional and aesthetic exits which may occur.

Age Factors

[Surgical correction of facial asymmetry].

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.

Adolescent

[Postankylosis condylectomy of the temporomandibular joint in a 5-year old girl. Report of a case].

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.

Ankylosis

[Indications for the surgical treatment of midfacial fractures in children].

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.

Adolescent

[Growth disorders following fractures of the midface in children].

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.

Adolescent

Profilocephalometric analysis: a combination of the cephalophotometric and the architectural-structural craniofacial analyses.

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.

Adolescent

[Maxillofacial sequelar manifestations of Silverman's syndrome].

The Silverman's syndrome or "child abuse syndrome" consist in several symptomes whose about 50% are maxillo-facial ones. These which are must often unknown at the initial stage, are responsible for an after effect syndrome, involving very significant nasal, oral, labial and buccal lesions. The anomalies of facial growth are the results of chronic lesions of cartilagenous septum and of nose bone area. A better understanding of this syndrome should held to diagnose it as quickly as possible. Indeed children are endangered by a lack of protective measures.

Battered Child Syndrome