Guillaume Captier

Sonographic assessment of normal fetal palate using three‐dimensional imaging: a new technique

The aim of this study was to describe a novel three‐dimensional (3D) ultrasound rendering technique to examine the normal fetal posterior palate and to assess its correspondence with the real fetal anatomy.

A new approach for peri-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block.

Background:  Congenital cleft palate (CP) is a common and painful surgical procedure in infants. CP repair is associated with the risk of postoperative airway obstruction, which may be increased with administration of opioids, often needed for analgesia. No described regional anesthesia technique can provide adequate pain control following CP repair in infants. The primary aim of this prospective and descriptive study was to observe the effectiveness of bilateral maxillary nerve blocks (BMB) using a suprazygomatic approach on pain relief and consumption of rescue analgesics following CP repair in infants. Analgesic consumption was compared to retrospective data. Complications related to this new technique in infants were also reviewed.

Accuracy of prenatal three‐dimensional ultrasound in the diagnosis of cleft hard palate when cleft lip is present

To investigate the accuracy of prenatal axial three‐dimensional (3D) ultrasound in predicting the absence or presence of cleft palate in the presence of cleft lip.

Neural symmetry and functional asymmetry of the mandible

Even in the absence of malformation or skull base asymmetry, the mandible may be physiologically asymmetric and this remains a major challenge in the orthodontic treatment. The mandible is a bone formed by a primary subunit, i.e., the neural part, with different functional secondary subunits, so we suggest that in a normal mandible the asymmetry was caused by the secondary functional subunit and the neural part is nearly symmetric. Eighty-three dry human mandible samples were studied. The measurements of the size of the mandible (corpus, ramus, mandible notch, condylar process, the angle of the mandible) and the neural subunit (the mandibular canal and the position of the mental and mandibular foramina) were measured bilaterally. The left and right sides were compared according to the dental status: 60 dentate and 23 edentulous mandibles. The calculation of the symmetry was based on the paired Student t test, the absolute difference |R−L| and the relative absolute difference |R−L|/|R+L|×100. The mandibular canal and the position of the foramina were symmetric, except for the position of the mandibular foramen in relation to the mandible notch. The symmetry was not modified by the dental status. The total length of the mandible and the length of the ramus were greater on the left side independently from the dental status. The length of the corpus and the mandible angle were symmetric in each group. The mandible notch was always asymmetric and its height was greater in the dentate group. The condylar process was the most asymmetric structure in each group. The primary subunit of the mandible, surrounding the mandibular canal, is a symmetric component of the mandible and is not modified by the dental status. The angle of the mandible between the corpus and ramus is another symmetric parameter that is important for the facial architecture. The ramus and especially the mandibular notch as well as the condylar process are the most asymmetric subunits influenced by the functional matrices.

Evidence of a Vocalic Proto-System in the Baboon (Papio papio) Suggests Pre-Hominin Speech Precursors

Language is a distinguishing characteristic of our species, and the course of its evolution is one of the hardest problems in science. It has long been generally considered that human speech requires a low larynx, and that the high larynx of nonhuman primates should preclude their producing the vowel systems universally found in human language. Examining the vocalizations through acoustic analyses, tongue anatomy, and modeling of acoustic potential, we found that baboons (Papio papio) produce sounds sharing the F1/F2 formant structure of the human [ɨ æ ɑ ɔ u] vowels, and that similarly with humans those vocalic qualities are organized as a system on two acoustic-anatomic axes. This confirms that hominoids can produce contrasting vowel qualities despite a high larynx. It suggests that spoken languages evolved from ancient articulatory skills already present in our last common ancestor with Cercopithecoidea, about 25 MYA.

Anatomic study using three-dimensional computed tomographic scan measurement for truncal maxillary nerve blocks via the suprazygomatic route in infants.

A maxillary nerve block using external anatomic landmarks is a safe regional anesthesia for adults. However, the classic approach to the nerve may be difficult in infants. To use this block in infants, we describe the anatomical landmarks needed to reach the foramen rotundum area using the suprazygomatic route. Computed tomographic scans of 55 infants (mean age, 8.5 months; range, 1 week to 16 months) without any malformation were retrospectively evaluated using multimodal and multiplanar software. For each side, the distances and angles from the skin to the greater wing of the sphenoid and to the foramen rotundum area (representing the maxillary nerve) were measured in the axial and oblique planes. The distances from the skin at the frontozygomatic angle to the greater wing of the sphenoid in the axial plane and the foramen rotundum area in the oblique plane are 24.1 mm ± 2.7 and 47.4 mm ± 4.1, respectively. From the skin landmark, the direction of the trajectory was oriented 19.3 ± 5.3 and 8.7 ± 2.9 degrees forward. These distances and angles must be slightly adapted for infants younger than 6 months, although none of these parameters were correlated with age during the period studied. This anatomic study based on computed tomographic scan information may be useful for clinical application of the truncal maxillary nerve block in infants using the suprazygomatic route.

Study of carpal bone morphology and position in three dimensions by image analysis from computed tomography scans of the wrist

The morphology and positioning of the carpal bones were studied in three dimensions in 18 normal adults on computed tomography (CT) scans of the wrist. The digital data from each CT scan were processed to extract the carpal bones and to automatically characterize their geometry (geometric centroid, principal axes of inertia) using specific software tools. Biometric and angular parameters were defined for this purpose, and most of these parameters showed a normal distribution. The mean distance between the geometric centroid of the capitate and that of the triquetrum, expressed as a relationship to the length of the first principal axis of inertia of the capitate, was found to be the greatest (157.6%±8.4%), whereas the smallest mean distance was between the hamate and triquetrum (91.4%±7.3%). In the sagittal plane, the first principal axis of inertia of the bones of the first carpal row projected in front of the vertical axis of the orthogonal reference system, whereas the first principal axis of the capitate projected behind it. Measurements using this methodology are far more numerous than those from standard plain radiographs and have the additional advantage of being independent of the examiner. Future investigations on normal wrists should provide a normal range for each quantitative parameter, and comparative study of normal and pathologic wrist measurements should help to define the most relevant parameters for specific traumatic pathologies of the wrist.

Prenatal assessment of the normal fetal soft palate by three‐dimensional ultrasound examination: is there an objective technique?

To describe a three‐dimensional (3D) ultrasound technique for assessing the fetal soft palate.

Classification and pathogenic models of unintentional postural cranial deformities in infants: plagiocephalies and brachycephalies.

Unintentional postural deformities of the skull have increased in a pseudoepidemic manner in the last 15 years. Although dorsal decubitus and prenatal risk factors can play a role in the genesis of such deformities, we think that a crucial determinant is a postnatal defect of cervical mobility responsible for the infants posture (ie, positional preference) when supine. Indeed, muscular factors, which limit the range of head and neck movements, have been underestimated in the genesis of skull deformities. Here, we have retrospectively analyzed data from 181 infants with unintentional skull deformities and propose a classification of these deformities into 3 types based on their pathogenic model and clinical appearance: fronto-occipital plagiocephalies due to severe muscle hypertonia in which the myogenic component is the first implicated, occipital plagiocephalies with muscle imbalance due to neurogenic muscle hypertonia, and posterior brachycephalies with neurogenic muscle hypertonia of the suboccipital muscles due to trauma to the occipitovertebral junction. Future studies on the size and density of specific muscles or group of muscles should help us to better understand their involvement in the pathogenesis of postural deformities. Our findings also highlight the importance of carefully assessing cervical mobility during the first week of life to detect possible limitations and to prescribe (if needed) an adapted rehabilitation. Rehabilitation should be associated with postural measures put in place when infants sleep supine to prevent the appearance of skull deformations.

Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate

We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n=20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n=20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p=0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p=0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p=0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p=0.019). No patients in the Talmant group had an oronasal fistula (p<0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.