Karel G.H. van der Wal

Relapse and Stability of Surgically Assisted Rapid Maxillary Expansion: An Anatomic Biomechanical Study

PURPOSE This anatomic biomechanical study was undertaken to gain insight into the underlining mechanism of tipping of the maxillary segments during transverse expansion using tooth-borne and bone-borne distraction devices. MATERIALS AND METHODS An anatomic biomechanical study was performed on 10 dentate human cadaver heads using tooth-borne and bone-borne distraction devices. RESULTS The amount of tipping of the maxillary halves was greater in the tooth-borne group, but the difference was not significant. Four of the specimens demonstrated an asymmetrical widening of the maxilla. CONCLUSIONS Segmental tipping was seen in both study groups. In this anatomic model, tooth-borne distraction led to greater segmental tipping compared with bone-borne distraction. Keep in mind, however, that this anatomic model by no means depicts a patient situation, and any extrapolation from it must be done with great care. The fact that the tooth-borne group demonstrated greater tipping might reflect the general opinion that bone-borne distraction causes less segmental angulation than tooth-borne distraction. Some tipping was seen in the bone-borne group, suggesting that overcorrection to counteract relapse will be necessary with this treatment modality.

Three-dimensional airway changes after Le Fort III advancement in syndromic craniosynostosis patients.

Background: To investigate the changes of upper airway volume in syndromic craniosynostosis patients following Le Fort III advancement, computed tomographic scans were analyzed and related to the amount of advancement. Methods: In this retrospective study, the preoperative and postoperative computed tomographic scans of 19 patients with syndromic craniosynostosis who underwent Le Fort III advancement were analyzed. In four cases, preoperative polysomnography demonstrated obstructive sleep apnea. The airway was segmented using a semiautomatic region growing method with a fixed Hounsfield threshold value. Airway volumes of hypopharynx and oropharynx (compartment A) and nasopharynx and nasal cavity (compartment B) were analyzed separately, as was the total airway volume. Advancement of the midface was recorded using lateral skull radiographs. Data were analyzed for all patients together and for patients with Crouzon/Pfeiffer and Apert syndromes separately. Results: Airway volume increased significantly in compartment A (20 percent; p = 0.044) and compartment B (48 percent; p < 0.001), as did total airway volume in (37 percent; p < 0.001) in the total study group. No significant differences in volume changes were found comparing Apert with Crouzon/Pfeiffer patients. No distinct relation could be found between advancement of the midface and volume gain either in the total study group or in Apert and Crouzon/Pfeiffer patient groups separately. Postoperative polysomnography showed significant improvement of obstructive sleep apnea in all four patients. Conclusions: A significant improvement of the upper airway after Le Fort III advancement in syndromic craniosynostosis patients is demonstrated. No distinct relation could be observed between advancement and airway volume changes.

Orbital change following Le Fort III advancement in syndromic craniosynostosis: Quantitative evaluation of orbital volume, infra-orbital rim and globe position

Patients with syndromic craniosynostosis suffering from shallow orbits due to midface hypoplasia can be treated with a Le Fort III advancement osteotomy. This study evaluates the influence of Le Fort III advancement on orbital volume, position of the infra-orbital rim and globe. In pre- and post-operative CT-scans of 18 syndromic craniosynostosis patients, segmentation of the left and right orbit was performed and the infra-orbital rim and globe were marked. By superimposing the pre- and post-operative scans and by creating a reference coordinate system, movements of the infra-orbital rim and globe were assessed. Orbital volume increased significantly, by 27.2% for the left and 28.4% for the right orbit. Significant anterior movements of the left infra-orbital rim of 12.0mm (SD 4.2) and right infra-orbital rim of 12.8mm (SD 4.9) were demonstrated. Significant medial movements of 1.7mm (SD 2.2) of the left globe and 1.5mm (SD 1.9) of the right globe were demonstrated. There was a significant correlation between anterior infra-orbital rim movement and the increase in orbital volume. Significant orbital volume increase has been demonstrated following Le Fort III advancement. The position of the infra-orbital rim was moved forward significantly, whereas the globe position remained relatively unaffected.

Intraorbital bamboo foreign body in a chronic stage: case report

A case of intra-orbital bamboo foreign body in a chronic stage is presented. This case seems to confirm the importance of radiological examination, including three-dimensional computed tomography to choose the optimal surgical approach to remove the foreign body.

Oral Manifestations of Oxalosis : A Case Report and Review of the Literature

m rimary hyperoxaluria (PH) is a metabolic autosomal ecessive disease that causes an error in oxalate meabolism. In 1957, Archer et al introduced the term rimary hyperoxaluria. Two types are known. In ype 1 the enzyme alanine glyoxylate aminotransferse, mostly made by the liver, is lacking. This results n accumulation of oxalate in mesoderm tissue and ncreased excretion of oxalate in urine. In type 2 an ncreased excretion of L-glycerate in urine is found. he disease is characterized by hyperoxaluria, nepholithiasis, nephrocalcinosis, and widespread tissue xalate deposits. The term oxalosis was given by haplin to describe deposits of calcium oxalate crysals in extrarenal tissue. Secondary forms of oxalosis lso exist. These are caused by ingestion of subtances that contain the oxalate ion or are metaboized to oxalate. Ingestion of excessive amounts of hubarb and ethylene glycol can also induce oxalate oxicity. PH eventually leads to end-stage renal failure. In ost patients this will occur in their teens in both ypes 1 and 2. In recent decades, life expectancy as increased because of hemoor peritoneal dialysis. n the past, kidney transplantations were carried out ith minimal success because the enzyme alanine lyoxylate aminotransferase was lacking. Therefore,

Bone grafting the piriform aperture deformity in isolated cleft lip patients: Indication, technique, and results

PURPOSE This study was undertaken to determine the effect of a bone graft in the piriform aperture on the nasal deformity and orthodontic treatment of the cleft side teeth in isolated cleft lip patients. PATIENTS AND METHODS All primary cleft lip repair was done 3 months after birth. Nine patients, four female and five male, with a mean age of 12.5 years (range, 8.2 to 24.8 years) and with a repaired cleft lip, were bone grafted between 1992 and 1996. The mean postoperative period was 2 years (range, 1 to 4 years). An iliac crest bone graft was placed in the piriform aperture deformity on the side of the cleft lip. The improvement in the nasal symmetry and angulation of the cleft side teeth were evaluated. The eight growing cleft lip patients (mean age, 11 years; range, 9 to 13 years) were compared with a control group of eight healthy growing children (mean age, 11 years; range, 9 to 13 years). The improvement of nasal symmetry was measured by the formula of the lobule portion of the columella index preoperatively and postoperatively. RESULTS The mean lobule portion of the columella index preoperatively was 41.8% (SD, 4.4%; SE of Mean, 1.5%) and postoperatively was 44.2% (SD, 4.9%; SE of Mean, 1.6%) (P > .006, t-test for paired samples). The angulation of the cleft side teeth was improved by orthodontic treatment. CONCLUSION Bone grafting the piriform aperture deformity results in a stable result and improves nasal symmetry and the angulation of the cleft side teeth.

Development of a keratocyst in the facial soft tissues.

Abstract The clinical signs, diagnosis, and therapy of a keratocyst of the soft tissues in a 27-year-old man are described. Part of the keratocyst lining probably grew through the bony window after extraoral biopsy or was implanted in the soft tissue during the procedure, accounting for the location of the lesion.

Facial contour reconstruction in partial lipodystrophy using two temporalis muscle flaps: A case report

A patient is presented with a partial lipodystrophy whose facial deformity was treated by means of rotation of the posterior part of the two temporalis muscles. A coronal approach with preauricular extension as well as an intraoral approach was utilized. Adequate facial symmetry was achieved by filling out the cheeks and upper lip.

Gingival Overgrowth in Pompe Disease: A Case Report

Pompe disease, or glycogen storage disease type 2, is a rare inheritable metabolic disease caused by a deficiency of the lysosomal enzyme acid α-glucosidase. Patients with the classic infantile form of Pompe disease present with symptoms during the first 3 months after birth, and most will die within their first year. Recently, enzyme replacement therapy (ERT) with recombinant human α-glucosidase became commercially available for Pompe disease. This is a case report of an 8-year-old girl with the infantile form of Pompe disease who is one of the longest survivors through ERT. The patient was tetraplegic when she started ERT. At age 3 years, she developed massive gingival overgrowth and could not close her mouth, prompting a reduction of the gingival overgrowth surgically. We expected that massive accumulation of glycogen would explain the gingival overgrowth. However, histopathology of the gingiva tissue showed marked glycogen accumulation in smooth muscle cells of the arteries, but the glycogen content in fibroblasts did not exceed that of control individuals. Further, there was an increase of immature collagen in the connective tissue, and signs of a mild chronic inflammation. We concluded that glycogen storage is not a direct causative factor of gingival overgrowth in our patient. Chronic inflammation, dryness of the gingiva, or even the minimal glycogen accumulation in the fibroblasts may have played a role.

Facial Reconstruction on the Abnormal Skull Model of a Living Patient

OBJECTIVE The concept of using a skull as the armature upon which to reconstruct a face has been understood for many years. The objective of this study was to blindly test this technique by using a skull that was reconstructed from the computed tomography (CT) scans of a living 48-year-old man. DESIGN The patient had a bilateral cleft lip, alveolus, and palate. A model of the complete skull produced by a computer-controlled milling machine that used data from the CT scans was used for the reconstruction. Surgery was then performed, and new dental prostheses were also constructed. After surgery, a second model of the relevant part of the skull was made and the reconstruction modified accordingly. CONCLUSION Despite having no information about the patient apart from that which could be gleaned from the model skull, the reconstructions demonstrate the approximate appearance of the face before and after surgery. Even without the extra information routinely available in forensic cases, a face broadly similar to that of the living patient could be achieved.