L.N.A. van Adrichem

Advancement of the midface, from conventional Le Fort III osteotomy to Le Fort III distraction: review of the literature

Since its introduction in about 1950, the Le Fort III (LF III) procedure has become a widely accepted treatment for correction of midface hypoplasia and related functional and esthetic problems. As long-term surgical experience grows and improvements are made in technique, equipment and peri-operative care, the number of LF III procedures performed worldwide is increasing. A number of fundamental questions concerning the technique remain unclear, and large, conclusive studies are lacking owing to the relative rarity of severe midface hypoplasia. This literature review aims to address problems, such as the indication field, timing of surgery, rate of relapse and the use of distraction osteogenesis. An overview of the history and technique of LF III osteotomy and distraction is provided, together with a comprehensive review of the available clinical data.

The role of three‐dimensional ultrasound in visualizing the fetal cranial sutures and fontanels during the second half of pregnancy

The aim of this study was to evaluate the significance of three‐dimensional (3D) ultrasound in visualizing fetal cranial sutures and fontanels and to determine factors that could influence visualization and image quality.

Craniofacial variability index in utero: a three‐dimensional ultrasound study

This study was undertaken to develop a craniofacial pattern profile analysis by three‐dimensional (3D) ultrasound and to introduce a craniofacial variability index (CVI) which can assist in the evaluation of fetal facial anatomy.

Changes of mandibular ramal height, during growth in unilateral hemifacial microsomia patients and unaffected controls

The aim of this study was to design mandibular ramal height growth curves for patients with HFM and compare those with the curves for a Dutch reference population. Two hundred fifty-one pre-operative orthopantomograms (OPTs) from 84 patients with unilateral HFM were used in conjunction with a control set of 2260 OPTs from 329 healthy individuals from the Nijmegen Growth Study (NGS) to determine mandibular ramal distances. For grades I/IIa and IIb/III, and for both sides, growth curves were constructed for mandibular ramal height with a linear curve-fitting procedure. This procedure revealed a significant difference between HFM patients and the NGS control group (p < 0.001); both in the mild and severe group mandibular ramal height differed significantly between the affected and non-affected side (p < 0.001). Growth was similar between HFM patients and the NGS control group. HFM patients therefore start with a smaller mandible and end with a smaller mandible, but experience growth similar to the Dutch normal population. These growth curves may aid the timing and determination of the combined surgical orthodontic treatment plan for HFM patients.

The frequency of Le Fort I osteotomy in cleft patients

Objective The aim of this research was to study the frequency of Le Fort I osteotomy (LFI) in cleft patients treated according to the protocol of the Erasmus University Medical Center, Rotterdam. Design Retrospective cohort study. Patients 508 cleft patients born between January 1, 1983, and December 31, 1992, were evaluated. Main Outcome Measures Frequency of LFI and correlations with type and extent of cleft, gender, number of previous surgical procedures, age during alveolar augmentation, and missing teeth, respectively. Results 251 patients met the inclusion criteria. Overall, 28 of the 251 patients (11.2%) required LFI: none for cleft lip (0.0%); 2 of 43 (4.7%) for cleft lip and alveolus; 24 of 100 (24.0%) for cleft lip, alveolus, and palate; 2 of 50 (4.0%) for cleft palate; and none for submucous clefts or the miscellaneous group (0.0%). The frequency of LFI increased with the severity of the cleft type. The number of previous surgical interventions is significantly higher in cases with an indication for LFI (p < .001). The frequency of LFI is significantly higher in male cleft patients (p < .05). Conclusions The overall frequency of LFI in the study group was 11.2%; this increased with the severity of the cleft type. A significant difference was noted in the number of previous surgical interventions between patients with and without an indication for an LFI. Delayed closure of the hard palate in the protocol might have influenced the low frequency of LFI.

Craniofacial variability index determined by three‐dimensional ultrasound in isolated vs. syndromal fetal cleft lip/palate

This study was undertaken to employ craniofacial pattern profile analysis in fetal facial clefts and to evaluate the craniofacial variability index (CVI) in distinguishing between isolated and syndromal clefts.

Distraction assisted treatment of a unilateral complex facial cleft.

Unilateral maxillary hypoplasia is a characteristic feature of an oblique facial cleft. This three-dimensional shortage of osseous structures and soft tissue becomes more prominent over the years and is difficult to correct. The authors describe a 17-year-old boy born with a unilateral nasomaxillary dysplasia and nasal dysplasia (Tessier type 1, 2, 3) who underwent a hemi-Le Fort III distraction with a rigid external distraction (RED) system. This distraction, in combination with initial peroperative advancement and retained with elastic traction with a facial mask, achieved a substantial horizontal improvement of the hemi-midface; this resulted in a better projection of the left cheek, infra-orbital rim, nasal ala, and improved occlusion. Owing to the underdevelopment of the maxilla and zygoma in all three dimensions, contour deformities remain. Creating several bone segments for multidirectional distraction would jeopardize vascularization of the bone. Good long-term planning is essential in these complicated cases, and more long-term results need to be assessed. The major reconstructive challenge for this complex pathology continues.

P088: Three‐dimensional sonographic assessment of different aspects of normal fetal craniofacial development during the second half of pregnancy

Objective: The most common indication for neonatal renal ultrasound is the antenatal finding of pyelectasis followed by suspected renal anomaly. Some of the latter have a characteristic appearance suggesting the diagnosis. This 5-year audit of 778 neonates reviewed the outcome of those with persisting pyelectasis and renal anomalies and suggested protocols for investigation. Method: The Mercy Hospital for Women is a tertiary referral obstetric and gynaecology hospital with a level-3 neonatal intensive care unit and approximately 5000 deliveries a year. A computer search of neonatal renal scans for the years 1996–2000 was made. Neonates with persisting pyelectasis and renal anomalies were reviewed. A micturating cystourethrogram (MCU) was requested in a number of infants. Vesicoureteric reflux (VUR) was classified according to the International Classification of Reflux. The results of investigations and outcome are reported. Results: In the 5 years, 25,204 babies were born at the Mercy Hospital for Women, 778 neonates (3%) were referred for renal ultrasound. The results were classified according to the postnatal diagnosis. Of 592 (76%) with normal postnatal scans, 49 had an MCU and 19 had VUR. There were 120 (15%) with persisting pyelectasis, 15 (13%) with VUR, not always ipsilateral. There were 7 with unilateral renal obstruction. There were 59 (8%) with structural anomalies including multicystic dysplastic kidney (MCDK), anatomic variants, ureterocoeles, reflux nephropathy, polycystic kidney disease and urethral obstruction. Conclusion: In this consecutive series, there were 100 (13%) neonates with significant abnormalities, structural anomalies, unilateral renal obstruction and VUR affecting clinical management. Protocols for investigation of neonates with persisting pyelectasis, severe hydronephrosis and renal anomalies are suggested.

Photoacoustic imaging in phantom materials and in vivo

Photo-acoustics (PA) is a technique, which can be used as the basis for non-invasive medical tomography. It is based on the absorption contrast between the biological target and the surrounding tissue and as a result of that does not suffer from strong light scattering. This fact makes PA suitable for imaging of the microvasculature in skin (532nm) or of deeper structures by using infrared light. In this paper, we present images of a vasculature cast, which was obtained by a Wistar rat and measurements on the absorption coefficient of Evans Blue.

Assessment of Volumetric Changes With a Best-Fit Method in Three-Dimensional Stereophotograms

Objective Different three-dimensional stereophotogrammetry systems and analyzing methods exist that often use landmarks for comparison. Measurement errors in landmark or surface comparison are mostly within 1 mm, which seems clinically acceptable. The aim of this study was to validate a three-dimensional stereophotogrammetric best-fit method of assessing volumetric changes and to compare three devices. Methods The validation of the best-fit method was at first done on a life-size dummy head. Scans were made in the ideal position, as well as in four additional positions, and a scan was made in which a soft putty specimen was added to the dummy head. The comparison was executed with a best-fit method using triangulation. Students t tests were used to detect statistically significant differences. Second, comparisons were made among scans of a white man in the ideal position and with volume changes added. Results The different positions tested for the dummy head showed no significant volume differences within each system or among systems. The differences found when adding a soft putty specimen fell into the same range as the differences between various positions. The differences within a live situation were 10 times greater compared with the dummy-head situation. Conclusions In a dummy-head situation, the different systems gave similar results when tested with a best-fit method. However, in live situations the differences may become 10 times greater, possibly due to different facial expressions. These differences may become clinically relevant and, therefore, further research in volumetric changes is needed.