David J. Reisberg

Monobloc craniomaxillofacial distraction osteogenesis in a newborn with severe craniofacial synostosis: A preliminary report

Severe craniofacial synostosis can be a devastating problem for a newborn infant. Reasons for early surgical intervention include cranial stenosis, hydrocephalus, inadequate globe and corneal protection, compromised airway patency, and feeding problems. In this preliminary report, we describe the management of severe craniofacial synostosis in a newborn infant by means of cranial and midfacial distraction osteogenesis.

Intraoral-Appliance Modification To Retract the Premaxilla in Patients With Bilateral Cleft Lip

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolabium is covered with soft denture liner. This appliance is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.

Modified nasal alveolar molding appliance for management of cleft lip defect.

Nasal alveolar molding is used effectively to reshape the nasal cartilage and mold the maxillary arch before cleft lip repair and primary rhinoplasty. It provides aesthetic and functional benefits of nasal tip and alar symmetry and improved dental arch form. At The Craniofacial Center at the University of Illinois at Chicago, the authors have developed a modification of a nasal alveolar molding appliance previously described in the literature. The key modification is the use of an orthodontic wire from the palatal prosthesis with an acrylic bulb positioned inside the nose, underneath the apex of the alar cartilage, as the nasal stent. This modification allows easier adjustment of the position of the bulb during treatment to achieve a more symmetrical relationship between the nasal cartilages, columella, philtrum, and alveolar segments.

Hygiene procedures for implant-retained facial prostheses

Implant-retained facial prostheses offer several advantages over facial prostheses that are retained with conventional skin adhesive. However, implant-retained prostheses also require additional hygiene procedures to maintain them in good condition and to keep the implants and retentive elements free of debris and the surrounding skin healthy. This article describes additional hygiene procedures to maintain the implant-retained prostheses.

Measuring Progressive Soft Tissue Change With Nasoalveolar Molding Using a Three-dimensional System

Background: For craniofacial orthodontics and surgery to progress, accurate temporal evaluation of soft tissue and skeletal change with treatment is necessary. Evolution in three-dimensional imaging eliminates certain inherent challenges in making such measurements in infants with facial clefts. Objective: The aim of this pilot study was to measure progressive three-dimensional changes in nasal form in a series of infants with facial clefts during the course of presurgical nasoalveolar molding. Materials and Methods: In 5 infants with unrepaired cleft lip and palate, three-dimensional photographs were obtained using the 3dMD system (3dMD, Inc, Atlanta, GA) at 2-week intervals during nasoalveolar molding treatment. Using the 3dMD Vultus software, temporal soft tissue changes were evaluated quantitatively based on three-dimensional linear measurements of 3 landmarks in the nasal area and qualitative changes in the surface shell. Results: Increase in columellar length on the cleft side and decrease of the nostril floor on the noncleft side were observed in all subjects. Progressive changes were observed most significantly in week 4 (T3) into treatment. Conclusions: This pilot study describes an approach using the 3dMD photo system with Vultus software for measuring the progressive change in the nasal soft tissues. The 3dMD system was believed to be valuable for facial analysis in this setting.

Nasal conformer to restore facial contour

Surgical removal of the nose may have devastating psychologic effects on the patient. This article describes the fabrication and use of a nasal conformer to restore facial contour until a definitive nasal prosthesis can be made.

Nasal outcomes of presurgical nasal molding in complete unilateral cleft lip and palate.

Objective. Short-term nasal forms following primary lip repair were compared between presurgical nasal molding and control groups. Aim. To compare nasal symmetry between patients that had nasal molding and lip repair with those that had only lip repair. Design. Retrospective case-control study Patients. Complete unilateral CL+P patients had basilar and frontal photographs at two time points: (1) initial (2) postsurgical. 28 nasal molding patients and 14 control patients were included. Intervention. Presurgical nasal molding was performed prior to primary lip repair in intervention group. No nasal molding was performed in control group. Hypothesis. Nasal molding combined with lip surgery repair according to the Millard procedure provides superior nasal symmetry than surgery alone for nostril height-width ratios and alar groove ratios. Statistics. Shapiro-Wilk test of normality and Students t-tests. Results. A statistically significant difference was found for postsurgical nostril height-width ratio (P < .05). No other statistically significant differences were found. Conclusions. Nasal molding and surgery resulted in more symmetrical nostril height-width ratios than surgery alone. Alar groove ratios were not statistically significantly different between groups perhaps because application of nasal molding was not early enough; postsurgical nasal splints were not utilized; overcorrection was not performed for nasal molding.

The importance of auricular prostheses for speech recognition

OBJECTIVES To examine the effects of an auricular prosthesis on sound levels at the entrance of the ear canal by measuring the auricular prosthesis transfer function (APTF) and to determine the effect of the prosthesis on speech recognition in noisy hearing conditions. METHODS Eight prostheses were used to measure the APTF. A microphone at the entrance of the ear canal measured sound pressure levels with the prosthesis present or absent while the head was rotated 360 degrees at 30 degrees increments. The Hearing in Noise Test was modified by the APTF to simulate the absence of an auricular prosthesis. Speech recognition was measured by testing 11 subjects with the unmodified Hearing in Noise Test and the modified Hearing in Noise Test. RESULTS The APTF changed with the heads position relative to the speaker. The mean (SD) maximal gain provided by an auricular prosthesis was 8.1 (2.7) dB at 4.6 (1.0) kHz and 9.7 (1.7) dB at 11.5 (0.9) kHz at 0 degrees rotation. During speech testing, the auricular prosthesis improved the mean (SD) signal to noise ratio by 1.7 (1.7) dB at 0 degrees (P< .001), 0.9 (2.2) dB at 90 degrees (P=.04), and 0.5 (2.3) dB at 180 degrees (P=.52). CONCLUSIONS The acoustic gain provided by an auricular prosthesis increases speech recognition in noisy environments. Auricular prostheses not only restore aesthetics but also improve hearing.

A new device for creating and positioning an autogenous cartilage framework during microtia reconstruction.

Objective: This paper describes the fabrication and use of a three‐dimensional appliance, known as the microtia surgical positioner, to more accurately position and better sculpt the autogenous rib cartilage graft during microtia reconstruction.

An intraoral positioning appliance for stereotactic radiotherapy

Stereotactic radiotherapy provides the most accurate and effective therapy and protects the adjacent, normal tissues. The head must be positioned the same for all treatments. This article describes the fabrication and application of a noninvasive intraoral appliance that verifies the position of the head to deliver more accurate radiotherapy and protect the adjacent, normal tissues.