ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Morphological characteristics of the “cleft face” were analyzed by calculating proportion indices in young adults who had undergone surgery in childhood for cleft lip and/or palate: 592 in 37 subjects with unilateral clefts and 432 in 27 with bilateral clefts. Three areas of the face with 16 indices based on 12 projective linear measurements were analyzed in each subject: 5 indices in the general face, 6 in the upper face, and 5 in the lower. Although a balanced relationship was found in two thirds of the indices assessed, severe disproportions, which greatly influence appearance, were noted in about one quarter. In the general face, the most frequent abnormal anthropometric findings contributing to severe disproportions were small upper‐face height and a severely high or moderately narrow mandible. In the soft tissues, disproportions included wide nose, small nasal tip protrusion, and short or long columella. Deviations from normality were rarely noted in the nose and upperlip height, mouth width, total facial height, and width of the upper face. In the upper face, severe disproportions occurred much more frequently in bilateral cleft subjects (67.6%) than in unilateral clefts (30.3%). In the lower face, however, severe disproportions were twice as frequent among unilateral clefts (39.4%) than bilateral (14.7%). The results, although interesting, require complementary preoperative data for reliable analysis of the adult “cleft face.”

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Distraction osteogenesis has proven to be an effective technique for the correction of mandibular deficiencies. However, problems have been encountered in achieving a final, idealized form of the mandible when using distraction devices capable of moving the bone segments in only one dimension (uniplanar). Specifically, occlusal irregularities and deficiencies in lower facial contour have been seen following uniplanar distraction. To address these problems, a distraction device capable of independent movements in three planes (multiplanar) was developed. Previously reported studies in a canine model have demonstrated that this device can successfully distract the mandible along both the sagittal axis (anteroposterior or z‐axis) and the vertical axis (superoinferior or y‐axis). This study examines the ability of the multiplanar device to distract along the sagittal and horizontal axes (mediolateral or x‐axis). A total of 12 dogs were included in the study. All animals underwent unilateral or bilateral mandibular distraction using an external multiplanar device. After a latency period of 5 days, primary distraction along the anteroposterior axis at a rate of 1mm/day for 10 days (10mm total) was performed. During the following 10 days, along with an additional 11mm to 20mm of anteroposterior axis distraction, concomitant secondary distraction was performed along the horizontal (mediolateral) axis at a rate of 5°/day (50° total). Cephalometric radiographs were obtained preoperatively and at the conclusion of both anteroposterior and combined anteroposterior‐mediolateral distraction. Computed tomography (CT) scans were obtained preoperatively and at the end of consolidation (28 days), after which all animals were sacrificed and the dry skulls examined. In all animals, distraction along the mediolateral or x‐axis was found to change the anteroposterior projection of the mandible. Varus angulation of the device with respect to the midline of the mandible caused compression of the distracted segments and reduced the anteroposterior thrust of the mandible. In contrast, valgus positioning of the device, with respect to the midline of the mandible, created the opposite effect, increasing the distracted length in the anteroposterior direction. The bone (mandibular) segments being distracted assumed the orientation of the device only for valgus positioning of the device (producing a decrease in the bigonial distance). Conversely, there was no effect from the mediolateral angulation on the distracted segments during varus positioning of the device. A possible explanation for this finding may be a greater resistance to an increase in the bigonial distance (varus positioning of the device) posed by obstruction of lateral movement of the condyle. This stands in contrast to a decrease in the bigonial distance observed following valgus positioning of the device. These findings confirm the clinical impression that distraction along the anteroposterior or sagittal axis remains the critical or keystone therapeutic maneuver in distraction of the mandible. Mediolateral or horizontal axis distraction is best used only as a supplementary movement; in essence, it only affects the anteroposterior dimension withlittleimpact on clinically relevant changes to the bigonial distance.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Although certain principles for management of facial fractures have not changed, new avenues reach this goal with greater precision and less morbidity. By reviewing these recent developments one can see the enormous potential for future develpments in technology, techniques, and biomaterials. Development of tertiary care centers for the multiple trauma victim has improved management of facial trauma by bringing a large experience to a team of individuals where creativity flourishes. Major leaps in diagnostic skills and technology now allow us to answer some to the controversial treatment issues in facial trauma. This article hopes to review some old concepts and look at new approaches in managing facial fractures.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Congenital teratoma of the oropharyngeal cavity is a unique clinical entity that poses immediate threats to the neonate in the postpartum period. Establishment of a secure airway is a primary goal after delivery; complete surgical resection is the subsequent guiding principle of management. Even more rare than teratomas confined to the oropharynx are tumors that extend into the intracranial cavity during development. Descriptions of these lesions in the medical literature are uncommon. In the majority of these reports, the tumors are associated with stillbirth, perinatal death, or significant morbidity after attempted resection. We present the rare case of a patient with congenital oropharyngeal teratoma with intracranial extension who has demonstrated long‐term survival without any neurological or functional deficits. A unique delayed staged approach to resection of the extracranial and intracranial components of the tumor is described.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Micrognathia complicated by edentulous maxilla was treated by performing sagittal‐split mandibular osteotomy and immobilizing a subperiosteal implant using transmaxillary screws. The patient was a 42‐year‐old man who had a birdlike facial deformity caused by significant hypoplasia of the mandible. He also demonstrated significant malocclusion attributable to micrognathia and edentulous maxilla caused by resorption of the alveolar bone. These conditions impaired his mastication and articulation, making it impossible for him to eat regular food or carry out normal conversation. A subperiosteal implant was placed on the edentulous maxilla, and was rigidly immobilized to the maxilla using five transmaxillary screws. A prosthesis was then attached to the implant, and by using the implant as the point of reference and the anchor, the mandible was moved forward by sagittal‐split mandibular osteotomy. Intermaxillary fixation was subsequently performed. The postoperative course has been favorable, and his facial complexion has improved significantly. One and a half years after his surgery, there has been no sign of complications or malocclusion caused by mandibular retraction. He is now able to eat regular food and speak normally.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Maxillarydistraction osteogenesisis a challenging technique to treat severemaxillary retrusion. Maxillary advancement by distraction has the advantage to provide new bone in combination with simultaneous expansion of the soft‐tissue functional matrix.Cleft lip and palatepatients can present with severe maxillary retrusion and Class III malocclusion. Two 13‐year‐old patients, born with nonsyndromic cleft lip and palate, underwent maxillary distraction—one had a bilateral, the other a unilateral complete cleft lip and palate. Maxillary advancement was performed using an external distraction device in combination with titanium miniplates as a skeletal maxillary anchorage. After a complete Lefort I osteotomy with pterygomaxillary disjunction, a latency period of 3 days was respected. On the fourth postoperative day, distraction was initiated at the rate of 1mm/d. Preoperative clinical photographs, dental casts, lateral cephalograms, and panoramic radiographs were taken. Further lateral cephalograms were obtained after the latency period, after completion of the active period of distraction, at the completion of the consolidation period, and at 6 and 12 months postoperatively. The aesthetic outcome was excellent and skeletal advancement of 8 and 7mm was measured without dentoalveolar compensations.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;A total of 40 patients with varying degrees of facial skeletal deformity and Class III malocclusion were treated by bimaxillary osteotomy combining maxillo‐malar augmentation and/or osseous genioplasty at the same sitting by the author. In all patients, the maxillary advancement and mandibular set back were performed, using Le Fort I maxillary osteotomy and bilateral sagittal split osteotomy of the mandibular rami. In additional bimaxillary osteotomy, simultaneous maxillo‐malar augmentation and genioplasty in 20 patients, genioplasty in 12 patients, maxillo‐malar augmentation in eight patients, were performed to improve facial harmony. All patients were followed clinically and radiographically for at least 1 year and as much as 5 years after undergoing surgical correction. No cases with relapse or other major complications have been encountered up to now. There were, however, persisting unilateral inferior alveolar nerve damage in two patients, prolonged nerve anesthesia or hypoesthesia in four patients, and short period anesthesia or hypoesthesia in 11 patients, wide alar base in three patients and slight deviation of cartilage septum in two patients. There were no other complications encountered and an unexpected result. The facial skeletal deformity and malocclusion were always treated satisfactorily as patient and plastic surgeon's expectations in one‐stage operation, without significant complications and morbiditiy.

ISSN:1049-2275    

出版商:OVID    

年代:2000

数据来源: OVID