Staged Surgical Correction of Severe Panfacial and Transverse Nasal Root Asymmetry in Unicoronal Synostosis.

Nasal asymmetry is widely acknowledged to be one of the most difficult deformities to manage. Most reports in the literature pertain to corrective methods in relation to isolated deformity of the dorsum in the posttraumatic patient. There is a paucity of literature relating to management of nasal radix asymmetry, and still less in the context of severe panfacial asymmetry.

Nasolabial angle and nasal tip elevation changes in profile view following a Le Fort I osteotomy with or without the use of an alar base cinch suture: a long-term cohort study.

Objectives: Cinch sutures attempt to counteract alar base widening but may lead to unintended increases in the nasolabial angle and nasal tip elevation. The aim of this investigation was to assess nasolabial angle changes after maxillary osteotomies with and without alar base cinch sutures in the short and long terms.

Study Design: Seventy-eight patients were assessed, with 51 in the cinch group (38 females, 13 males; age range 16-39 years) and 27 in the no-cinch group (12 females, 15 males; age range 17-27 years).

Effectiveness of botulinum toxin B in the treatment of drooling.

The aim of this audit was to assess the effectiveness of botulinum toxin B (NeuroBloc(®), Eisai Ltd.) in the treatment of drooling. Over a period of 18 months patients treated with NeuroBloc(®) botulinum toxin (BTX) for serious drooling (drooling score more than 7) were invited to complete a questionnaire on their experience of drooling and the impact of treatment.

Long-term complications associated with permanent dermal fillers.

We report a case series of patients with serious long-term complications associated with the injection of permanent dermal fillers. Although such complications are relatively rare, the consequences are potentially life-long, and the psychological and medical effects can often have a profound impact on the patient. The continued routine offering of these treatments will require doctors to communicate effectively with patients about the nature of the complications and the probability of risk compared with alternative treatments.

Correcting the typical Apert face: combining bipartition with monobloc distraction.

Background: Bipartition distraction is a novel procedure combining frontofacial bipartition and monobloc distraction. Apert syndrome and other syndromic craniofacial dysostoses are often characterized by hypertelorism, with a negative canthal axis and counterrotated orbits. Central midface hypoplasia can result in a biconcave face in both midsagittal and axial planes.

Spectrum of Antley-Bixler syndrome.

Antley-Bixler syndrome (ABS) is an exceptionally rare craniosynostosis syndrome characterized by radiohumeral synostosis present from the perinatal period. There is a wide spectrum of anomalies seen within ABS, and other features include midface hypoplasia; choanal stenosis or atresia; multiple joint contractures; visceral anomalies, particularly of the genitourinary system; and impaired steroidogenesis. The condition of ABS is curious in that mutations of 2 separate genes have been identified and that there seem to be subtle phenotypic differences between the 2 genotypes.

Ocular advancement in monobloc distraction.

Background: Monobloc distraction has been demonstrated to be an efficacious, safe, and stable method of providing functional and aesthetic improvement in children with syndromic craniosynostosis. Although the movement of bony structures following monobloc distraction has been quantitatively assessed before, objective analysis of the movement of soft tissues, such as the globe, has not been published previously. The authors present a method that assesses globe movement following monobloc distraction, using computed tomographic scan data.

The evaluation of bony union after frontofacial distraction.

Frontofacial advancement by distraction osteogenesis using the rigid external distraction device has become an accepted treatment for the deformity associated with craniofacial dysostoses (e.g., Crouzon, Apert, and Pfeiffer syndromes).

Three-dimensional image analysis of facial skeletal changes after monobloc and bipartition distraction.

Background: Both monobloc and facial bipartition distraction are important tools for correcting functional and aesthetic problems in patients with syndromic craniosynostosis. Three-dimensional computed tomographic reconstructions have become increasingly useful in planning and analyzing surgical results. This study measured the differential deformation of the facial skeleton following distraction osteogenesis with the rigid external distractor frame, looking especially at correction of the midface concavity.

Submental intubation in orthognathic surgery: initial experience.

Submental intubation is a technique for use in maxillofacial trauma, which allows precise assessment of changes to the nasolabial complex, midlines, cants, and incisal display in patients having maxillary orthognathic surgery. We report our initial experience of it used as an adjunct in the management of orthognathic surgery in a series of 44 patients.

Functional outcomes in monobloc advancement by distraction using the rigid external distractor device.

Background: Craniofacial dysostosis syndromes produce multisutural synostoses combined with severe midfacial retrusion. This may cause serious functional problems, including airway obstruction, exposure of the eyes, visual pathway dysfunction, and raised intracranial pressure. Early midface advancement may be necessary to address these issues.

Monobloc distraction in an infant, using the rigid external distractor: problems and solutions--a case report.

Introduction: Patients with craniofacial dysostosis frequently develop functional problems including raised intracranial pressure, ocular dysfunction, obstructive sleep apnoeas and failure to thrive. These functional problems can be treated by a number of different techniques. The monobloc frontofacial advancement has the ability to correct all of these functional problems in one procedure, but can be associated with high morbidity particularly in the young infant.

Relapse following frontofacial advancement using the rigid external distractor.

Multisutural synostosis may result in frontofacial hypoplasia. The aesthetic and function problems arising from this can be corrected by frontofacial advancement, either by monobloc or bipartition osteotomy. Significantly larger, safer advancements can be achieved using distraction osteogenesis when compared to conventional osteotomy.

The oral implications of caustic soda ingestion in children.

The morbidity related to caustic soda (sodium hydroxide) ingestion is well described in the literature. The majority of publications have concentrated on the effects to the trachea and gastrointestinal tract, with little reference to the oral and peri-oral areas. Accidental ingestion of sodium hydroxide-containing substances is fortunately rare; however the consequences can be devastating.

Transmigration of a maxillary canine. A case report.

In the oral cavity, transmigration is defined as a tooth that crosses the mid-line by more than half its length. Following extensive literature review, it was found that, although well documented with respect to mandibular canines, there were only two publications detailing maxillary cuspid transmigration. This report presents a case of transmigration where the left maxillary canine gradually crossed the mid-line and migrated to the right side in a patient with hemifacial microsomia and cleft palate.

Oral manifestations of systemic diseases.

In the clinical examination for systemic diseases, inspection of the oral cavity is often overlooked. This area provides a wide array of clinical signs that may help the clinician establish a diagnosis. This article provides a summary of the more common oral manifestations of systemic disease.

Midline odontogenic infections: a continuing diagnostic problem.

Cutaneous sinus tracts and facial swellings of odontogenic origin have been well documented in the literature. These lesions however continue to be incorrectly diagnosed resulting in inadequate and unnecessary treatment. This paper reports two cases of midline odontogenic infections presenting as skin lesions.

Comparative reproducibility of three methods of radiographic assessment of alveolar bone grafting.

The aims of this study were to compare the reproducibility of three radiographic methods of assessing the quality of alveolar bone grafts, namely the Bergland, Kindelan and Chelsea Scales, and evaluate their application in the mixed and permanent dentitions. Additionally the use of occlusal versus periapical radiographs was assessed. Three examiners applied each scale on two occasions to the radiographs of 48 cleft lip and palate patients who had received alveolar bone grafts in 59 sites (11 had bilateral clefts).