Karl-Victor Sarnäs

Tooth Size and Tooth Formation in Children with Advanced Hypodontia

Abstract No Abstract Available. From the Department of Orthodontics, Public Dental Health Service, and The Maxillo-Facial and Cleft Palate Center, University Hospital, Malmo, Sweden.

Roentgen stereometry with the aid of metallic implants in hemifacial microsomia.

Displacement of the mandible and the maxilla with growth in relationship to the frontal bone was recorded in eleven children with hemifacial microsomia, aged 3 to 14 years at the initial examination. The goals were to assess the efficiency of the method for accurate recording of articular growth and to obtain information on facial development in each of these children. Correction of the skeletal asymmetry was not attempted during observation periods of from 707 to 1,484 days. In continued observations three of the children were treated with functional appliances. Roentgen stereometry with the aid of metallic implants proved to be an efficient method for highly accurate recordings of articular facial growth in relationship to the frontal bone. Displacement of the jaws was asymmetrical in all of the examined children as determined in the frontal and transverse planes of the head. In about 50 percent of the children the degree of asymmetry increased in one plane while it decreased in the other plane. No correlation was found between the extent of the mandibular deformity, as seen on orthopantomograms, and the displacements of the mandible. Generally, the displacement of the maxillary bones corresponded with the displacement of the mandible. Articular growth of the jaws was redirected toward a more favorable pattern in two of the children during the time they used a functional appliance. In the third child the use of a functional appliance had no such effect.

Von Langenbeck or Wardill procedures for primary palatal repair in patients with isolated cleft palate--speech results

Sixty-six patients operated on for isolated cleft palate were evaluated as adults, and their speech was assessed clinically. Forty-four had undergone a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at the age of 18 months. Speech was judged subjectively by the patients themselves, and perceptual assessment was made by three speech pathologists. The remaining speech problems, mainly hypernasality, were moderate or severe in 7 (16%) of the patients in the von Langenbeck group, and in 7 (32%) in the Wardill group. On the other hand, the patients in the Wardill group had fewer fistulas closed, and fewer velopharyngoplasties. There were no significant differences between the two methods regarding speech in adulthood. The Wardill method produced significantly more scar tissue clinically, which carries the potential risk of inhibition of facial growth. The present speech results will therefore be weighed against the outcome of maxillofacial growth for these patients.Sixty-six patients operated on for isolated cleft palate were evaluated as adults, and their speech was assessed clinically. Forty-four had undergone a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at the age of 18 months. Speech was judged subjectively by the patients themselves, and perceptual assessment was made by three speech pathologists. The remaining speech problems, mainly hypernasality, were moderate or severe in 7 (16%) of the patients in the von Langenbeck group, and in 7 (32%) in the Wardill group. On the other hand, the patients in the Wardill group had fewer fistulas closed, and fewer velopharyngoplasties. There were no significant differences between the two methods regarding speech in adulthood. The Wardill method produced significantly more scar tissue clinically, which carries the potential risk of inhibition of facial growth. The present speech results will therefore be weighed against the outcome of maxillofacial growth for these patients.

Hemifacial microsomia treated with the Herbst appliance: Report of a case analyzed by means of roentgen stereometry and metallic implants☆

The effect of Herbst appliance treatment on facial growth of one patient was recorded in terms of displacement of the mandible and the maxillary bones in relation to the frontal bone. The recordings were made with an accuracy of 0.1 degree and 0.05 mm. (S.D.). Before treatment the jaws were displaced posteriorly and to the affected side with growth, increasing the degree of retrognathia and facial asymmetry. During treatment facial growth was redirected and the jaws were displaced anteriorly and to the unaffected side, decreasing th degree of retrognathia and asymmetry. At the same time, however, the tilt of the mandible to the affected side was increased, possibly because of the morphologic and functional conditions of the jaws in hemifacial microsomia. The dental malocclusion was corrected partly through displacement of the jaws and partly through dentoalveolar adaptation.

Movement of maxillary segments after expansion and/or secondary bone grafting in cleft lip and palate: A roentgen stereophotogrammetric study with the aid of metallic implants

The study was undertaken to examine the effects of expansion treatment and secondary bone grafting in cleft lip and palate. Movement of the lateral maxillary segments in four patients with complete bilateral cleft lip and palate (BCLP) was complicated and asymmetric, and a greater relative widening of the dental arch was observed. The least expansion was found in the oldest patient. Bone grafting did not bring about a stable relationship between the segments. The width of the dental arch was mostly maintained despite segmental movement. In one patient with unilateral cleft of the lip and primary palate (UCL) growth in the midpalatal suture followed the pattern observed in noncleft patients but was less extensive. Accurate and comprehensive recording of the relatively small maxillary movements requires that implant stability is checked and that a reference is established outside the maxilla.

Roentgen Stereophotogrammetry Applied to the Cleft Maxilla of Infants: I. Implant Technique

A new roentgen stereophotogrammetric method was developed for the study of the kinematics of the skeletal system. Based upon the use of metallic implants, this method determines the relationship between the implants as well as the change in position between skeletal segments provided with implants. The object and its positional changes or motion are reconstructed from two roentgenograms with the aid of photogrammetric principles and computer technique. The method requires insertion of three or more implants in each skeletal segment. When the implants remain in a stable interrelationship during the observation period a rigid-body model is obtained. In the analysis this represents the segment and motion is computed according to the kinematics of a rigid body. The present study is concerned with early establishment of rigid-body models in the segments of a cleft maxilla (part I) and registration of postoperative motion between the segments (part II). The experimental set-up consists of two X-ray tubes (0.6×0...

Posteroanterior traction in maxillonasal dysplasia (Binder syndrome): A roentgen stereometric study with the aid of metallic implants☆

The study was undertaken to examine the effect of posteroanterior traction in an 11-year-old boy with maxillonasal dysplasia. Movement of the maxillary bones and of the mandible was recorded, by means of roentgen stereophotogrammetry, in relationship to the frontal bone during and after treatment. In the examined child face-mask therapy mainly influenced the position of the mandible while the recorded advancement of the maxillary bones was slight (0.6 mm.). It is possible that the limited maxillary response to traction may be due to insufficient growth capacity of the circummaxillary sutures in a child with maxillonasal dysplasia. While movement of the maxillary bones and of the mandible during traction conformed with the pattern of treatment effect described by Delaire a total maxillary relapse occurred in the posttreatment observation period (no retention), possibly in adaptation to the retropositioned mandible. In our patient, posteroanterior traction accomplished improvement of the maxillary retrusion in relationship to the mandible only.

Maxillary and mandibular displacement in hemifacial microsomia: a longitudinal Roentgen stereometric study of 21 patients with the aid of metallic implants.

Objective To record maxillary and mandibular displacement with articular growth and in response to bimaxillary surgical repositioning in patients with hemifacial microsomia (HFM) and to observe ipsilateral corpus/ramus growth in severely affected children. Design Prospective roentgen stereometric analysis (mean age 7 years 10 months to 18 years 0 months) and retrospective profile and panoramic roentgenograms. Mean total observation period was 9 years 1 month. Setting Department of Plastic and Reconstructive Surgery, Malmö University Hospital (Malmö, Sweden). Patients Twenty-one patients consecutively diagnosed from 1976 through 1988 with HMF, five of whom had bimaxillary surgery. Interventions Surgery was performed at the Department of Plastic and Reconstructive Surgery. Implants were inserted at the initial reconstructive surgical procedure under general anesthesia. Roentgen examinations were performed in connection with continued clinical evaluations and treatment. Main Outcome Measures Stereo roentgenograms were digitized at the Department of Orthopedic Surgery, Malmö University Hospital (Malmö, Sweden). Results Displacement of the jaws with articular growth and in response to bimaxillary surgical repositioning varied interindividually with no apparent common pattern. Relapse displacement occurred several years after bimaxillary surgery. Mandibular growth changes were found in the corpus/ramus area and alveolar process on the affected side. Conclusions A marked interindividual variability of maxillary and mandibular displacement indicates that the relevance of statistical analysis of HFM growth data may be questioned. We would suggest that precise and accurate longitudinal recordings of growth and response to surgery in individual HFM patients be more appropriate.

Analysis of Motion of Skeletal Segments following Surgical-Orthodontic Correction of Maxillary Retrusion

The indicators in the bottom plates, as viewed from the respective foci, are used to compute the mathematical relationship between the coordinate systems of the image and that of the calibration cage. The indicators in one of the bottom plates define the coordinate system of the calibration cage that is, the laboratory coordinate system. The indicators in the top plates are used to compute the positions of the roentgen foci (F1 , F~) in the laboratory coordinate system. Thus all indicators serve as calibration points, which are recorded on the same roentgenogram as the object. The object is described by indicators inserted in the facial skeletal segments to be studied. The image of an object indicator on the roentgenogram is denoted as an object point.

ADULT SKELETAL PROFILE IN ISOLATED CLEFT PALATE: A COMPARISON OF THE VON LANGENBECK AND WARDILL PROCEDURES FOR PRIMARY REPAIR OF THE PALATE

Sixty-four adult patients operated on for isolated cleft palate were evaluated with regard to facial skeletal morphology using conventional radio-cephalometry. Dental occlusion was assessed clinically. Forty-two had had a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at 18 months. The mean error of the method was 0.7 degree for angular, and 0.9 mm for linear, measurements. The group with clefts had less maxillary prognathism (s-n-ss), more maxillary inclination (NSL/NL), more retroclined lower incisors (ILI/ML), and shorter total and upper facial heights (n-gn, n-sp) compared with the reference group. Multiple regression analysis was used to evaluate differences between the two treatment regimens. Explanatory variables in addition to surgical technique were sex, severity of cleft, and presence of a velopharyngeal flap. Only one variable, lower incisor inclination (ILI/ML), was different for the two regimens. Ten (24%) in the von Langenbeck group had a lateral cross-bite compared with one (5%) in the Wardill group. Other variables in a multivariate regression analysis were affected by sex and severity of cleft to various degrees. This study showed no obvious differences in facial skeletal morphology that could be attributed to surgical technique. Factors other than technique, including sex, age, and severity of cleft merit attention.Sixty-four adult patients operated on for isolated cleft palate were evaluated with regard to facial skeletal morphology using conventional radiocephalometry. Dental occlusion was assessed clinically. Forty-two had had a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at 18 months. The mean error of the method was 0.7° for angular, and 0.9 mm for linear, measurements. The group with clefts had less maxillary prognathism (s-n-ss), more maxillary inclination (NSL/NL), more retroclined lower incisors (IL I /ML), and shorter total I and upper facial heights (n-gn, n-sp) compared with the reference group. Multiple regression analysis was used to evaluate differences between the two treatment regimens. Explanatory variables in addition to surgical technique were sex, severity of cleft, and presence of a velopharyngeal flap. Only one variable, lower incisor inclination (IL I /ML), was I different for the two regimens. Ten (24%) in the von Langenbeck group had a lateral cross-bite compared with one (5%) in the Wardill group. Other variables in a multivariate regression analysis were affected by sex and severity of cleft to various degrees. This study showed no obvious differences in facial skeletal morphology that could be attributed to surgical technique. Factors other than technique, including sex, age, and severity of cleft merit attention.