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PubMed1978

Lecithin/sphingomyelin ratio in amniotic fluid and its value for the prediction of neonatal respiratory distress syndrome in pregnant diabetic women.

In 101 diabetic pregnant women (Classes A through D) 146 determinations of the lecithin/sphingomyelin (L/S) ratio were carried out. Gestational ages were verified by serial fetal cephalometry. No L/S ratios of more than 2.0 were found before 34-1/2 weeks' gestation; however, in 42 per cent of patients the L/S ratio was below 2.0 at 36 weeks' gestation or later. Respiratory distress syndrome (RDS) was found in 16 neonates of women with L/S ratios of 2.0 or higher; however, RDS incidence varied depending on the mode of delivery. Abdominal delivery was performed before 37 weeks' gestation in 19 patients with L/S ratios of 2.0 or higher and resulted in neonates with RDS in 41 per cent of cases. Vaginal delivery was accomplished below 37 weeks' gestation in 10 patients with L/S ratios of 2.0 or higher and no subsequent neonatal RDS was observed. After 37 weeks' gestation neonatal RDS is rare, irrespective of mode of delivery. The data presented suggest that similar numerical values of the L/S ratio at different gestational ages have a different predictive value for the occurrence of neonatal RDS.

Amniotic Fluid↗

PubMed1984

Diminished growth in fetuses born preterm after spontaneous labor or rupture of membranes.

We examined biparietal diameter, abdominal circumference, and birth weight in 148 preterm infants to assess fetal growth. A statistically significant proportion of preterm fetuses had biparietal diameter and abdominal circumference values below the fiftieth and tenth percentile levels as compared with that expected in normal fetuses. Similarly, birth weight of infants in the study fell significantly below the fiftieth and tenth percentiles relative to Brenner's curve. We conclude that diminished fetal growth is associated with early delivery secondary to preterm labor or preterm premature rupture of membranes or both. Additionally, since biparietal diameters in preterm fetuses are smaller than those of normal fetuses the prediction of gestational age by cephalometry should be advanced by 7 to 10 days.

Birth Weight↗

PubMed1996

The functional role of the adenoids in speech.

Illustrative cases are presented showing a variety of interrelationships between the adenoids and the activity of the velopharyngeal valve in speech. The cases presented were selected from a group of 1000 patients referred because of suspected velopharyngeal diseases. When appropriate, complete velopharyngeal assessment was made including otolaryngological speech and hearing examination, polysomnography, nasendoscopy, multiview videofluoroscopy and cephalometry. New observations are described which further elucidate the mechanism by which the adenoids may change the mechanism of velopharyngeal valving and consequently speech patterns. In conclusion, procedures involving the adenoids and tonsils and surgical correction of velopharyngeal valve abnormalities to improve respiratory function must be performed in a manner which ensures preservation of normal speech activity. Similarly, surgical correction of velopharyngeal valve abnormalities to improve speech activity must preserve its respiratory function. The velopharyngeal valve and the adeno-tonsils must be considered together whenever diagnosis and a therapeutic intervention of either of them is considered. A clinical method for patient evaluation, patient management and the development of a rational therapeutic approach is presented.

Adenoids↗

PubMed2005

The effects of guided tissue regeneration (GTR) on modified Le Fort I osteotomy healing in rabbits.

Osteogenesis following surgery depends on the osteoblasts at the wound site. Fibrous nonunions may be the result of differential and rapid migration of fibroblasts compared to osteoblasts into the wound. The present study was designed to test this hypothesis through the use of guided tissue regeneration (GTR) in a rabbit model. Bilateral, Le Fort I osteotomies (n=20) were produced in the maxillae of 10 New Zealand White rabbits. The segments were advanced 6mm and rigidly fixed using microplates and screws. One side was covered with a resorbable collagen membrane or left uncovered. Rabbits were followed for four weeks with radiographs and the maxillae were harvested for histology. Cephalometry revealed that membrane-covered defects had significantly (P<0.01) reduced defect area (by approximately 70%) compared to uncovered defects. Histologically, membrane-covered defects showed more organized osteogenesis and less fibrous tissue than uncovered defects. Histomorphometry revealed that membrane covered defects had significantly (P<0.05) reduced defect areas (by approximately 20%) compared to uncovered defects. While findings suggest that GTR can facilitate osseous wound healing in Le Fort I osteotomies, results also caution against relying exclusively on two-dimensional radiography to assess bony wound healing in lieu of three-dimensional imaging and evaluations.

Absorbable Implants↗

PubMed1984

Maternal serum alpha-fetoprotein measurement: a screening test for Down syndrome.

The median maternal serum alpha-fetoprotein (AFP) level at 14-20 weeks' gestation in 61 pregnancies associated with Down syndrome was 0.72 multiples of the median (MoM) value for a series of 36 652 singleton pregnancies unaffected by Down syndrome or neural-tube defect--a statistically significant reduction. The difference is great enough to form the basis of a screening test. By selecting for amniocentesis women with serum AFP levels less than or equal to 0.5 MoM at 14-20 weeks' gestation (excluding any of these that ultrasound cephalometry shows to have been due to the overestimation of gestational age) 21% of pregnancies with Down syndrome would be identified as well as 5% of unaffected pregnancies. If amniocentesis were offered to all women aged 38 years or more and, in addition, to younger women with serum AFP below specified maternal age-dependent cut-off levels (less than or equal to 1.0 MoM at 37 years, less than or equal to 0.9 at 36, less than or equal to 0.8 at 35, less than or equal to 0.7 at 34, less than or equal to 0.6 at 32-33, less than or equal to 0.5 at 25-31) 40% of pregnancies with Down syndrome and 6.8% unaffected pregnancies would be selected.

Adult↗

PubMed2001

[Imaging of oto-mandibular dysplasias].

The modern imaging opened a possibility of precise exploration of otomandibular dysplasias. The techniques of browsing by IRM and CT Scan and the software of image processing which is associated with these techniques (three-dimensional, superposition and removing of the anatomical structures) allow to carry out a true anatomical dissection of the whole of these malformative syndromes. The study of the skeletal anomalies gains by specifying the disorders of development of the various mandibular segments: temporomandibular joint, ramus and horizontal branch and also, all cranio-maxillar structures: orbital rim, cranial basis. Study of masticatory muscles shows an important damage correlated with skeletal troubles and performs a grading of morphological and functional gravity. This analytical study emphasizes some malformative axis: malar axis in cases of mandibulofacial dystosis, temporomandibular axis in hemifacial microsomia. Modern imaging can appreciate, by development of three-dimensional cephalometry, growth anomalies and quantification of post therapeutical results. At last usefulness of imaging appears in therapeutic modelisation and in the field of Computer-Aided Planning of surgical techniques of osteotomies and overall maxillaries distractions.

Ear↗

PubMed1982

Detection of the small-for-gestational age twin fetus by a two-stage ultrasound examination schedule.

Serial ultrasonic measurement of the biparietal diameter is an unsatisfactory means of detecting the small-for-gestational age (SGA) fetus in twin pregnancies. A new two-stage ultrasound examination schedule, highly effective in detecting the SGA singleton fetus, has been evaluated prospectively in 31 twin pregnancies. The schedule comprises ultrasonic assessment of gestational age in early pregnancy, followed by measurement of the product of the crown-rump length and trunk area of both fetuses at 34-36 weeks. All Nineteen SGA twin fetuses were detected using this schedule; the technique offers several other advantages over serial biparietal cephalometry.

Female↗

PubMed2007

Nasopharyngeal dimensions in magnetic resonance imaging and the risk of acute otitis media.

BACKGROUND: We have previously found by lateral cephalometry an association between nasopharyngeal anatomy and the risk of acute otitis media (AOM). We evaluate here the association of nasopharyngeal dimensions in magnetic resonance imaging (MRI) with the occurrence of AOM in otherwise healthy children. METHODS: Sixty-one healthy children (mean age 5.7 years, range 3.9-6.9) were recruited from child care centres. The parents filled in a questionnaire on the child's history of ear infections and adenoidectomy. MRI was performed with a 4 mm slice thickness during an upper respiratory infection. Five dimensions and two angles expressing the structure of the bony nasopharynx were measured in sagittal images. RESULTS: The dimension from the caudal edge of the septum to the midpoint of the sella, reflecting the height of the nasopharynx, was on average 2.2 mm smaller in the children who had had AOM attacks during the last 12 months than those without attacks (95% confidence interval (CI) 0.9 to 3.4, p=0.001) and the nasal base angle was on average 2.1 degrees smaller (95% CI 0.7 to 3.5, p=0.004). These differences remained significant after adjustment for age, sex and previous adenoidectomy in the logistic modelling. A history of adenoidectomy did not have any effect on the dimensions. CONCLUSIONS: The nasopharynx was smaller in the children with AOM attacks during the last year. The value of this finding for predicting susceptibility to recurrent AOM and directing preventive procedures should be evaluated.

Acute Disease↗

PubMed2001

The nature of human craniofacial growth studied with finite element analytical approach.

The purpose of this study was to elucidate the nature of human craniofacial growth by means of finite element method (FEM), and to compare the results with the current concept derived from morphometric studies with roentgenographic cephalometry (RCM). Lateral cephalograms were taken of 20 males and 20 females, and traced on acetate paper. On the tracing, the craniofacial complex was divided into seven areas or elements. Growth analysis was executed with FEM for changes in the size and shape of each area during six developmental periods from 4 to 18 years old. The size change in the male group exhibited a peak from 10 to 12 years old for the cranial base and upper facial skeleton, from 8 to 10 years old for the maxillary complex, and from 12 to 14 years old for the mandible. On the other hand, in the females, the size change was almost invariable from 4 to 12 years old and completed suddenly at 12 years old, which was earlier by a few years than in the males. An interesting finding is that changes in the size and shape were the most substantial in the maxillary complex, followed by those in the mandible, and the smallest in the cranial base and upper facial skeleton. It is shown that growth of the cranial base lasted up to 14 years old and the maxillary complex exhibited the greatest growth changes in the size among various anatomic structures. These findings may provide a new concept of human craniofacial growth, somewhat different from the previously established principles by RCM.

Journal Article↗

PubMed1997

Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects.

OBJECTIVES: It is well known that obstructive sleep apnoea-(OSA) is frequently associated with obesity. In the current study, we investigated the correlation between abdominal visceral fat accumulation and the presence of OSA in obese subjects. SUBJECTS: A consecutive series of 37 patients (17 men and 20 women) with primary obesity who were admitted to the Second Department of Internal Medicine. Osaka University Hospital, were investigated Patients with OSA were designated as those whose apnoea index (number of apnoea h-1 of sleep) was more than 5. MAIN OUTCOME MEASURES: The distribution of body fat was determined using computed tomographic sections. The upper airway dimensions were evaluated with indices obtained by cephalometry in both inspiratory and expiratory phases. RESULTS: Visceral adipose tissue (AT) area which was measured at the level of the umbilicus, and its ratio to total AT area were both significantly greater in OSA patients as compared with those in non-OSA patients. All subjects whose visceral AT area measured more than 220 cm2 manifested OSA. These two parameters also closely correlated with an increase in apnoea index. A multiple linear regression analysis revealed that the visceral AT area significantly correlated to apnoea index when age, AT mass and lean body mass were taken into account. The fluctuations of the upper airway were significantly greater in the large visceral fat group than in the small visceral fat group. CONCLUSIONS: These results suggest that visceral fat accumulation is an important risk indicator for OSA in obese subjects.

Adipose Tissue↗

PubMed2004

Observation of three cases of temporomandibular joint osteoarthritis and mandibular morphology during adolescence using helical CT.

Temporomandibular joint (TMJ) osteoarthritis (OA) is a potential cause of craniofacial deformity. If TMJ OA appears during orthodontic treatment, the mandible usually rotates posteriorly, resulting in an unsatisfactory profile, especially in patients with pre-treatment mandibular retrusion. Although it is important to confirm the kind of TMJ pathosis at the start of orthodontic treatment, the relationship between TMJ OA, condylar remodelling and changes in craniofacial morphology remains unclear because of a lack of longitudinal studies. Elucidating this relationship might allow better prediction of post-treatment craniofacial morphology. In the present case reports, helical computed tomography and cephalometry were used to analyse relationships between the pattern and location of condylar remodelling and the changes in craniofacial morphology in three patients with TMJ OA.

Adolescent↗

PubMed1986

[3-dimensional display of computed tomographic studies of craniofacial anomalies].

Craniofacial anomalies are conventionally investigated by cephalometry using ordinary radiographs and by computed tomography. Both methods have the major disadvantage of trying to demonstrate a complex three-dimensional structure, such as the skull, in two dimensions and they therefore cannot display a true spatial image. We present the principle underlying a three-dimensional display derived from computer tomographic studies and discuss the clinical application in the diagnosis of craniofacial anomalies.

Adolescent↗

PubMed2004

A systematic review of Swedish research in orthodontics during the past decade.

The aims of this systematic review were to identify the study designs and topics of Swedish orthodontic articles, to elucidate their international position, and to verify in which scientific journals the articles had been published in the past decade. A search of the Medline database for papers published between 1992 and 2002 was made using the Medical Search Heading terms 'orthodontics', 'malocclusion', 'cephalometry', and 'facial bones and growth'. Two independent reviewers selected the articles of Swedish origin and categorized each article according to research design and principal topic. Overall, 15,571 articles in orthodontic research were found, and the Swedish contribution was 1.9% with the majority of these (71.5%) being submitted by universities. Most of the Swedish articles (84.5%) had been published in 10 journals and many high-quality studies with orthodontic interest were published in non-orthodontic journals with higher impact factor scores than the orthodontic journals. Every second study was prospective, and of these, 15 (5.2% of all Swedish articles) were randomized clinical trials (RCTs). It was found that nearly every third study, prospective as well as retrospective, was uncontrolled. The main classification was treatment studies (51.9%), followed by development (18.6%) and diagnostic information (10.7%) studies. Thus, the majority of the articles evaluated therapeutic interventions; however, although the RCT is the preferred study design in evaluation studies, few used this method. In an era focused on evidence-based medicine, studies with an RCT design will be the future challenge for research in the field of orthodontics.

Dental Research↗

PubMed1998

Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement.

UNLABELLED: Twenty children, aged 4-9 years, underwent adeno/tonsillectomy because of unequivocal anamnestic nocturnal obstructive breathing. Preoperatively, apnea-hypopnea index was > 5 in 10 cases only, AI > 1 in 17. Nineteen children had signs of increased respiratory labour in movement recordings and inspiratory EMG-activity. Oxygen desaturation index was 0 in 7 children, and nadir SaO2 was > or = 90% in 10. Cephalometry and dentition study models initially revealed significant changes, chiefly lateral cross-bite (n = 11) and vertical growth direction of the mandible. Tonsillar size or duration of disease was not correlated with the severity of polysomnographic findings, nor were orthodontic variables. Symptoms disappeared promptly postoperatively. After one year, respiratory recordings were normalized or improved in the majority of children, and orthodontic variables normalized or improved in all children. CONCLUSION: Oximetry and airflow recordings may be normal in children who benefit from treatment of anamnestic nocturnal obstruction. Craniofacial deformities are common and improve significantly with surgical treatment of the airway obstruction.

Adenoidectomy↗

PubMed1991

Acoustic reflectometry for airway measurement. Principles, limitations and previous work.

Acoustic pulse reflectometry is a relatively recent technique which allows the non-invasive measurement of human airways. The technique consists of guiding an acoustic impulse through the subject's mouth and into the airway. Suitable analysis of the resulting reflection (the 'echo') allows a reconstruction of the area-distance function. The non-invasive nature of the technique offers significant advantages over the established methods of x-ray cephalometry and CT scanning, and makes it very attractive for the investigation of ENT problems and sleep apnoea, and in the anaesthetic management of patients. This paper describes the theory and limitations of acoustic reflectometry, discusses previous work, and suggests some modifications: it is currently being implemented clinically.

Acoustics↗

PubMed1999

Initial tooth displacement in vivo as a predictor of long-term displacement.

In the past, the dry skull has been used as a hypothetical model to test initial orthodontic and orthopaedic force systems. However, the question as to whether this hypothetical model can be used as a predictor of long-term displacements in vivo remains unanswered. In this study, an attempt was made to compare initial tooth displacement with the long-term effect after application of the force system for a longer period of time, in six adult dogs. Tooth displacement was obtained by applying a force by means of a coil spring (push) system. Following application of a force of 50 g in the first series (n = 3) and 80 g in the second series (n = 3), initial displacements were registered by means of speckle interferometry. The long-term displacement was registered by means of standardized cephalometry in the same dog by leaving the force system in place for 5 weeks. The mean values of the displacement vectors of the second premolars in the six dogs were compared. A paired t-test revealed no significant differences between the initial and long-term displacements in any of the dogs. The results show that both groups of measurements belong statistically to the same sample and that initial tooth displacement measured by means of speckle interferometry is a valuable predictor for forecasting long-term displacement in vivo after 5 weeks.

Animals↗

PubMed1993

Distraction of the frontal bone outside the cranial plane: a rabbit model.

Distraction of the frontal bone outside the cranial plane using the Ilizarov principle was performed in 17 22-week-old New Zealand white rabbits. Five rabbits had frontal bone osteotomy only and were in the control group; 5 rabbits were placed in the sham control group and had frontal bone osteotomy plus application of a customized headgear appliance; and 7 rabbits were placed in the experimental group, which underwent frontal bone osteotomy application of the headgear and distraction. The frontal bone was elevated 1 mm every other day for a period of 8 weeks, and the animals were then killed. Cephalometry was performed both preoperatively and at the end of the 8-week period. Histological examination of the skulls was also performed. The experimental group showed a significantly elevated frontal bone compared to the sham control group (p < 0.05). Callous bone filled the distracted segment, which united the frontal bone with the cranial plane. Therefore, frontal bone advancement by distraction osteogenesis is possible using this rabbit model.

Animals↗

PubMed1999

Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea.

OBJECTIVE: To describe a surgical procedure for the treatment of severe obstructive sleep apnea syndrome (OSAS), the procedure's indications, and its results. STUDY DESIGN: A retrospective study of 10 male patients with OSAS treated by tongue base reduction with hyoepiglottoplasty (TBRHE) at the Foch Hospital (Suresnes, France) between 1994 and 1997. Patients had a mean body mass index (BMI) of 32 kg/m2, a mean respiratory disturbance index (RDI) of 70 events/h, and a mean minimal oxygen saturation of 78%. They had refused positive airway pressure therapy or wished to discontinue it. METHODS: Subtotal tongue base reduction preceded by lingual neurovascular bundle identification and derouting, epiglottal verticalization, mouth floor horizontalization, and hyoid bone repositioning was performed, associated in some cases to uvulopalatopharyngoplasty (UPPP). Indications were based on a site-related obstruction, on the absence of craniofacial deficiencies, and on the presence of hyolingual abnormalities determined by cephalometry and magnetic resonance imaging. RESULTS: TBRHE associated to UPPP in most cases had an 80% success rate, based on a postoperative RDI below 20 events/h and a reduction of the preoperative RDI of more than 50%. Snoring and excessive daytime sleepiness decreased or disappeared, respectively, in 100% and 90% of the cases. No neurovascular complications occurred. CONCLUSION: TBRHE is a safe procedure for the neurovascular bundle. Associated to a pharyngotomy, it is an effective treatment for severe OSAS attributable to tongue base obstruction. These results require confirmation in a larger series of patients.

Adult↗