Janka Kochel

Face perception in patients with unilateral cleft lip and palate and patients with severe Class III malocclusion compared to controls

Although there is principal agreement that increased facial asymmetry is associated with decreased facial attractiveness, there are no studies analysing face perception in patients with a unilateral cleft lip and palate (CLP) (uCLP) compared to orthognathic Class III patients. To this end, three-dimensional (3D) data on the faces of 30 adults with a complete uCLP, 20 orthognathic patients with a severe skeletal Class III, and 20 adults with a skeletal Class I as a control group were generated. The 3D asymmetry of the facial soft-tissue was analysed. These data were compared with subjective ratings for attractiveness carried out by 100 laypersons. Compared to the controls, uCLP patients and orthognathic patients had a significantly higher facial asymmetry. No difference was found between uCLP patients and orthognathic patients. The attractiveness ratings showed that uCLP patients and orthognathic patients were rated less attractive compared to the controls. However, although there were no differences in the facial asymmetry between uCLP patients and orthognathic patients, the uCLP patients were rated significantly less attractive. This leads to the conclusion that not only the extent of asymmetry has an influence on attractiveness but also the location of asymmetry. For clinical use, these findings underline the importance of accurate as possible surgical reconstruction of the nasal morphology in uCLP patients.

Three-dimensional analysis of cranial growth from 6 to 12 months of age

The aim of this study was to generate three-dimensional data of the physiological growth of the infants cranium in the significant growth phase from 6 to 12 months of age. In a longitudinal observational study non-invasive 3D data using an optical surface scanner were generated of the entire head of 52 Caucasian infants (27 females and 25 males) between the ages of 6 (T1) and 12 (T2) months. The circumference of the head increased by 6.51 per cent (from 43.50 to 46.33cm). Analysis of width and length showed that the head grows 2.84 per cent more in length, resulting in a decrease in the cranial index of 2.52 per cent (from 83.87 to 81.76 per cent). The highest increment observed was in the total volume of the cranium, with an increase of 18.76 per cent (from 1229.01 to 1459.57cm(3)). Comparison of the left and right sides of the head by measuring the diagonal symmetry difference showed a difference of only 0.37cm. Overall, the symmetry-related parameters showed an almost symmetric development of the cranium in infants. The findings should provide valuable information on physiological growth and development of the infants cranium. Therefore the high growth rate of the cranium in the first year of life suggests that this period is a critical period in which the disruption of developmental processes may have long-lasting effects on the morphology of the cranium with a prognostically unfavourable effect of the further growth of the viscerocranium.

3D Soft Tissue Analysis – Part 1: Sagittal Parameters

Objective:The aim of this study was to develop a reliable threedimensional (3D) analysis of facial soft tissues. We determined the mean sagittal 3D values and relationships between sagittal skeletal parameters, and digitally recorded 3D soft tissue parameters.Patients and Methods:A total of 100 adult patients (nª = 53, nº = 47) of Caucasian ethnic origin were included in this study. Patients with syndromes, cleft lip and palate, noticeable asymmetry or anomalies in the number of teeth were excluded. Arithmetic means for seven sagittal 3D soft tissue parameters were calculated. The parameters were analyzed biometrically in terms of their reliability and gender-specific differences. The 3D soft tissue values were further analyzed for any correlations with sagittal cephalometric values.Results:Reproducible 3D mean values were defined for 3D soft tissue parameters. We detected gender-specific differences among the parameters. Correlations between the sagittal 3D soft tissue and cephalometric measurements were statistically significant.Conclusion:3D soft tissue analysis provides additional information on the sagittal position of the jaw bases and on intermaxillary sagittal relations. Further studies are needed to integrate 3D soft tissue analysis in future treatment planning and assessment as a supportive diagnostic tool.ZusammenfassungZielsetzung:Ziel dieser Untersuchung war die Entwicklung einer reliablen dreidimensionalen (3D) Analyse der Gesichtsweichteile. Es sollten sagittale 3D-Durchschnittswerte bestimmt werden und Beziehungen zwischen sagittalen skelettalen Parametern und digital erfassten 3D-Weichteilparametern dargestellt werden.Patienten und Methodik:In die Studie eingeschlossen wurden 100 erwachsene Patienten (nª = 53, nº = 47) kaukasischer Herkunft. Ausgeschlossen wurden Patienten mit Syndromen, LKGSSpalten, auffälligen Asymmetrien oder Anomalien der Zahnzahl. Es wurden arithmetische Mittelwerte für sieben sagittale 3DWeichteilparameter ermittelt. Die Parameter wurden biometrisch hinsichtlich ihrer Reliabilität und geschlechtsspezifischer Unterschiede analysiert. Des Weiteren wurden die 3D-Weichteilwerte bezüglich bestehender Korrelationen zu sagittalen kephalometrischen Werten untersucht.Ergebnisse:Für die 3D-Weichteilparameter konnten reproduzierbare 3D-Durchschnittswerte definiert werden. Innerhalb der Parameter ließen sich geschlechtsspezifische Unterschiede feststellen. Die Korrelationen zwischen den sagittalen 3D-Weichteilmessungen und den kephalometrischen Messungen waren statistisch signifikant.Schlussfolgerung:Die 3D-Weichteilanalyse lässt Aussagen sowohl über den sagittalen Einbau der Kieferbasen als auch über die sagittalen intermaxillären Beziehungen zu. Weitere Untersuchungen sind wünschenswert, um die 3D-Weichteildiagnostik zukünftig als unterstützendes diagnostisches Instrument in die Behandlungsplanung und -bewertung integrieren zu können.

Treatment modalities of infants with upper airway obstruction--review of the literature and presentation of novel orthopedic appliances.

Objective To present a new orthopedic method for treatment of infants with Pierre Robin sequence (PRS) and upper airway obstruction (UAO) as an alternative to other established nonsurgical and surgical techniques such as positioning, nasopharyngeal or endotracheal intubation, tongue-lip adhesion, extension, distraction, or tracheostomy. Design Review of the literature and presentation of novel orthopedic appliances. Setting Department of Orthodontics, Dental Clinic, Medical Faculty of the University of Wuerzburg, Germany, Department and Clinic of Pediatrics, Medical Faculty of the University of Wuerzburg, Germany, 2005 to 2008. Patients Seven patients with significant respiratory and feeding difficulties between 0 and 6 months of age. Both patients with nonsyndromic PRS and patients with syndromic PRS were included. Interventions The type of respiratory tract obstruction was defined by nasopharyngoscopy. Patients with type 1 obstruction received a plate with an epiglottic spur; whereas, patients with obstruction type 2, 3, or 4 received a plate with a pharyngeal tube. Results All patients were successfully treated with orthopedic appliances alone. Under plate therapy they showed good oxygen saturation and could consequently be better nourished orally. Conclusions The presented novel method is a noninvasive technique in treatment of infants with UAO.

3D Soft Tissue Analysis – Part 2: Vertical Parameters

Introduction:The increasing relevance of 3D methods in orthodontic diagnostics and treatment planning calls for the development of new analysis methods and the definition of three-dimensional mean values.Objective:The aim of this study was to develop a reliable threedimensional (3D) analysis of facial soft tissues. Our objectives were to determine vertical 3D mean values and define the relationship between vertical skeletal parameters and digitally-recorded 3D soft tissue parameters.Patients and Methods:A total of 100 adult patients (♀ = 53, ♂ = 47) of Caucasian ethnic origin were included in the study. Patients with syndromes, cleft lip and palate, noticeable asymmetry or anomalies in the number of teeth were excluded. Arithmetic means for three vertical 3D soft tissue parameters were calculated. The parameters were analyzed biometrically in terms of their reliability and gender-specific differences. Furthermore, the 3D soft tissue values were analyzed with regard to any correlations with vertical cephalometric values. In addition, we employed stepwise discriminant analysis, a multivariate statistical method, to examine the extent to which correct assessment of craniofacial morphology is possible by referring to those 3D parameters.Results:We successfully defined reproducible 3D mean values for the 3D soft tissue parameters, demonstrating highly significant correlations between the vertical 3D soft tissue measurements and cephalometric measurements. 89.8% of the patients could be correctly assigned to a vertical or horizontal craniofacial morphology according to the 3D soft tissue values.Conclusion:3D soft tissue analysis provides information about vertical skeletal parameters, allowing assessment of vertical craniofacial morphology. Further investigation will be required so that 3D soft tissue diagnosis can be integrated into treatment planning and assessment as a supportive diagnostic tool in the future.ZusammenfassungEinleitung:Die zunehmende Relevanz von 3D-Verfahren im Rahmen der kieferorthopädischen Diagnostik und Therapieplanung erfordert die Entwicklung neuer Analyseverfahren sowie die Definition dreidimensionaler Durchschnittswerte.Zielsetzung:Ziel dieser Untersuchung war die Entwicklung einer reliablen dreidimensionalen (3D) Analyse der Gesichtsweichteile. Es sollten vertikale 3D-Durchschnittswerte bestimmt werden und die Beziehung zwischen vertikalen skelettalen Parametern und digital erfassten 3D-Weichteilparametern dargestellt werden.Patienten und Methodik:In die Studie eingeschlossen wurden 100 erwachsene Probanden (♀ = 53, ♂ = 47) kaukasischer Herkunft. Ausgeschlossen wurden Probanden mit Syndromen, LKGS-Spalten, auffälligen Asymmetrien oder Anomalien der Zahnzahl. Es wurden arithmetische Mittelwerte für drei vertikale 3D-Weichteilparameter ermittelt. Die Parameter wurden biometrisch hinsichtlich ihrer Reliabilität und geschlechtsspezifischer Unterschiede analysiert. Des Weiteren wurden die 3D-Weichteilwerte bezüglich bestehender Korrelationen zu vertikalen kephalometrischen Werten untersucht. Darüber hinaus wurde mittels eines multivariaten statischen Verfahrens, der schrittweisen Diskriminanzanalyse, überprüft, inwieweit anhand der untersuchten 3DParameter eine korrekte Beurteilung des Gesichtsschädelaufbaus möglich ist.Ergebnisse:Für die 3D-Weichteilparameter konnten reproduzierbare 3D-Durchschnittswerte definiert werden. Es konnten hochsignifikante Korrelationen zwischen den vertikalen 3D-Weichteilmessungen und den kephalometrischen Messungen nachgewiesen werden. 89,8% der Patienten konnten anhand der 3D-Weichteilwerte korrekt vertikalem oder horizontalem Gesichtsschädelaufbau zugeordnet werden.Schlussfolgerung:Die 3D-Weichteilanalyse lässt Aussagen über vertikale skelettale Parameter zu und ermöglicht eine Beurteilung des vertikalen Gesichtsschädelaufbaus. Weitere Untersuchungen sind wünschenswert, um die 3D-Weichteildiagnostik zukünftig als unterstützendes diagnostisches Instrument in die Behandlungsplanung und -bewertung integrieren zu können.

New model for surgical and nonsurgical therapy in adults with Class III malocclusion

INTRODUCTION Not all adult Class III malocclusion patients are candidates for surgical correction. In patient assessment and selection, major issues remain regarding diagnosis and treatment planning. The purpose of this investigation was to ascertain whether adding a transverse parameter to a discriminant analysis could improve the classification of adults with Class III malocclusion into 2 groups of patients: those who can effectively be treated by orthodontic therapy and those who require orthognathic surgery. METHODS Cephalograms, plaster casts, and extraoral photos of 69 adults with Class III malocclusion were analyzed. A discriminant analysis was performed to identify the variables that best separate the 2 groups. RESULTS Stepwise variable selection resulted in a new, highly significant (P <0.0001) model of 4 variables that provided the best discriminant function to distinguish between patients with and without indications for surgical correction. The resulting equation was the following: score = -10.988 + 0.243 * Wits + 0.055 * M/M ratio + 0.068 * NSAr - 0.589 * mand MLD. The percentage of patients correctly classified by this equation was 91.3%. The sensitivity was 0.92, and the specificity was 0.89. CONCLUSIONS In the discriminant analysis, the mandibular midline deviation as a transverse component was included. The addition of the transverse variable led to an improved model concerning the predictive value in Class III malocclusion patients with surgical requirements.

3D stereophotogrammetric analysis of operative effects after broad median craniectomy in premature sagittal craniosynostosis

IntroductionThere is ongoing discussion on the diagnostic methods, the need of surgical treatment, and the surgical strategies for premature craniosynostosis.Materials and methodsThis study examined the operative procedure of a standardized broad median craniectomy, active tilting of the forehead, and bitemporal greenstick fracturing in children with premature sagittal craniosynostosis. To objectively analyze the direct surgical results, we used a 3D stereophotogrammetry scanner, as previously described.ResultsA 3D analysis showed a significant increase in the width, cranial index (CI), head and coronal circumferences, intracranial volume, and cranial base width after surgery. Head length was the only parameter that demonstrated a significant decrease postoperatively. Asymmetry and the 30° diagonal difference showed no significant changes.Conclusion3D stereophotogrammetry is a reliable and valuable tool with no side effects. It demonstrated that the extended surgical procedure achieves good postoperative results with a reduced length and increased width and, therefore, an improved CI. Additionally, the total intracranial volume was significantly increased after surgery.