1/66. Intraoral craniofacial manipulation.This case report demonstrates how to use intraoral mechanics to correct facial planes that are not parallel, namely the eye plane, ear plane and occlusal plane. Currently, our protocol states that the cranial and occlusal planes are treated first, followed by expanding (transversely or sagittally), if necessary, the maxillary arch to accommodate the dentition. This creates the template from which the remaining treatment will be rendered, which would include, proper TMJ position, correction of mandibular facial asymmetries that result from ramus growth deficiencies, (both frontal and profile), and determining the correct posterior vertical. At this point the case is in a Class I osseous relationship with all expansion completed. The teeth are then erupted into the correct positions for the orthodontic finishing of the case.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |
2/66. Radial forearm fasciocutaneous free flap as a solution in case of noma.The authors describe a case of noma or Cancrum Oris, an oral gangrenous disease, features more frequently found in children from developing countries. The clinical features, its ethiopathogenesis, and its particular link with different geographic and economic areas of the world, its clinical evolution as well as surgical treatment are all discussed. Underlined is the functional and organic aspect of this disease, in particular the distortion of the face, which commonly involves the full thickness of the cheek skin and bone, mandibular ankylosis and craniofacial dismorphisms, and the modern approach in reconstructive microsurgery. The authors report a case of a patient affected by noma, with a very evident left face dismorphism, where we found a brilliant solution using a left radial forearm fasciocutaneous free flap, appropriately shaped.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
3/66. Simultaneous distraction osteogenesis and microsurgical reconstruction for facial asymmetry.Restoring facial balance in patients with severe facial asymmetry is a challenging problem for the craniofacial team. attention to bony reconstruction as well as soft-tissue contouring is required for patients with moderate to severe deformities. Traditionally, facial skeletal reconstruction was performed with osteotomies and bone grafting. More recently, distraction osteogenesis has proven to be successful in achieving bone lengthening. For select cases, distraction osteogenesis has lessened the need for major skeletal procedures and has allowed earlier surgical intervention. The reconstruction of the soft tissues in facial asymmetry has generally been performed as a second-stage procedure after skeletal reconstruction. The disadvantage of these traditional approaches is that it requires two separate major operative procedures, with the accompanying increased morbidity, hospital stay, and cost. We present a patient with hemifacial microsomia and a grade III mandibular deformity, in whom both the hard- and soft-tissue deficiencies were corrected in one surgical procedure with mandibular distraction osteogenesis and soft-tissue augmentation with a vascularized parascapular osteocutaneous flap. The technique and results at 1-year follow-up are presented.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
4/66. Treatment planning and biomechanics of distraction osteogenesis from an orthodontic perspective.As in traditional combined surgical and orthodontic procedures, the orthodontist has a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning both the predistraction and postdistraction orthodontic care. Based on careful clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and evaluation of three-dimensional computed tomographic scans, the orthodontist, in collaboration with the surgeon, plans distraction device placement and the predicted vectors of distraction. Both surgeon and orthodontist closely monitor the patient during the active distraction phase, using intermaxillary elastic traction, sometimes combined with guide planes, bite plates, and stabilization arches, to mold the newly formed bone (regenerate) while optimizing the developing occlusion. Postdistraction change caused by relapse is minimal. growth after mandibular distraction is variable and appears to be dependent on the genetic program of the native bone and the surrounding soft tissue matrix. A significant advantage of distraction osteogenesis is the gradual lengthening of the soft tissues and surrounding functional spaces. Distraction osteogenesis can be applied at an earlier age than traditional orthognathic surgery because the technique is relatively simple and bone grafts are not required for augmentation of the hypoplastic craniofacial skeleton. In this new technique, the surgeon and the orthodontist have become collaborators in a process that gradually alters the magnitude and direction of craniofacial growth.- - - - - - - - - - ranking = 0.75keywords = craniofacial (Clic here for more details about this article) |
5/66. Mandibular distraction osteogenesis with multidirectional extraoral distraction device in hemifacial microsomia patients: three-dimensional treatment planning, prediction tracings, and case outcomes.Distraction osteogenesis of the craniofacial skeleton with the use of several different types of distraction devices (i.e., extraoral, intraoral, unidirectional, multidirectional, and customized) have been documented. However, the details of treatment planning and the method of predicting the distraction of the mandible in patients with hemifacial microsomia have not been published previously. This paper presents a technique for (1) three-dimensional treatment planning for mandibular distraction, (2) three-dimensional prediction tracings with conventional radiographs (panoramic, lateral, and posterior-anterior cephalometric), and (3) correlating the treatment planning and clinical applications. Lastly, 2 patients with hemifacial microsomia planned and treated with this approach are reported.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
6/66. Unilateral coronal synostosis treated by internal forehead distraction.A 1-year-old infant with left hemicoronal synostosis was treated by distraction osteogenesis of the craniofacial skeleton using an internal distraction device. Surgery was performed through a coronal incision. The frontal bone and upper half of both orbits were first osteotomized en bloc after minimal epidural dissection of the supraorbital area and no epidural dissection around the coronal osteotomy site. The lateral one fourth of the frontal bone, including the right lateral half of the orbit, was left intact. The internal distraction device was fixed in the left temporal area. A 0.5-mm per day rate of distraction was performed up to an elongation of 17 mm after a 5-day latency period. The distraction device was removed after a consolidation period of 2 months. The results obtained were satisfactory, with symmetry of the forehead, orbit, and nose achieved without complications. The merits of this procedure are no extradural dead space after the operation (which prevents infection), shortened operative time, reduced blood loss, filling in the bone gap created by advancement with new bone, acceptable cosmesis by the parents during distraction, and no fixation device left after the second operation.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
7/66. Saethre-Chotzen syndrome: review of the literature and report of a case.Saethre-Chotzen syndrome is an autosomal acrocephalosyndactyly syndrome whose gene has been assigned to chromosome 7p (TWIST). A case of a 13-year-old girl with Saethre-Chotzen syndrome (ACS III) is described. The features of the syndrome include: turriplagiocephaly with a cranial circumference of 52 cm, facial asymmetry, low hairline, proptosis, antimongoloid slanting of palpebral fissures, nasal deviation with high bridge, angled ears, scoliosis and torticollis, clinodactyly of the fourth and fifth toes, large halluxes, and neurosensorial hypoacusia. For correction of the deformity, a cranioorbital remodeling was performed. The craniofacial approach with remodeling of the frontal bar and reduction of the turricephaly resulted in a satisfactory morphological and functional outcome, with complete three-dimensional reshaping and remodeling of the frontonasoorbital area.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
8/66. Craniofacial characteristics of klippel-feil syndrome in an eight year old female.A female eight year, one month old patient with klippel-feil syndrome has been introduced. General appearance of the patient was characterized by short neck with limited head movements, craniofacial asymmetry, low posterior hairline and a short stature. Cephalometric analysis revealed a Class I dentoskeletal pattern with an excessive mandibular plane angle and fused cervical vertebrae. Panoramic radiogram showed congenitally missing lower second premolars and right central incisor.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
9/66. Fibrous ankylosis after distraction osteogenesis of a costochondral neomandible in a patient with grade III hemifacial microsomia.Distraction osteogenesis has recently become a mainstay for treatment of craniofacial syndromes with mandibular hypoplasia. This article presents the difficult case of a patient with a previous costochondral rib graft who underwent mandibular distraction and developed a fibrous pseudoarthrosis at the distraction site. This was attributed in part to an associated temporomandibular joint ankylosis. Resorption of the pseudoarthrosis occurred once the distractor was removed. It appears that distraction osteogenesis of a mandible with an ankylosed temporomandibular joint can result in healing with a fibrous union, presumably because of movement at the distraction site when masticating. This can result in a pseudo "temporomandibular joint" at the distraction site. A temporomandibular joint arthroplasty was performed, followed by repeat distraction. We conclude that if there is an ankylosed temporomandibular joint or a stiff temporomandibular joint that may ankylose during the course of the distraction process, then a temporomandibular joint arthroplasty should be performed before or at the time the distractor is placed.- - - - - - - - - - ranking = 0.25keywords = craniofacial (Clic here for more details about this article) |
10/66. Intraoral craniofacial manipulation by using MRI appliance.This case illustrates the use of the Maxillary-rotation-Impaction Appliance (MRI) to rotate and impact the maxilla. When this maneuver was completed the transverse expansion screw widened the maxillary arch. The case was completed using fixed orthodontic appliances. The result is that the facial bones appear in the correct position and the teeth are correctly positioned in the face with a class I occlusion.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |
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