Manuel Yudovich Burak

Usefulness of tridimensional cephalometry in diagnosis and surgical treatment planning when compared to bidimensional cephalometry in patients with craniofacial anomalies

The aim of this study was to compare cephalometric results of three and two dimensional surgical predictions in patients that underwent orthognatic surgery. The study involved two groups of 15 to 30 years old patients with craniofacial anomalies. The fi rst group of patients had orthognatic surgery from April 2004 to January 2005. Pre and post-surgical lateral cephalometric measurements were done using Simplant program, (version CMF 8.2 of Materialise, NV, Belgium). The second group of patients had orthognatic surgery from January 1999 to January 2004. Pre and post-surgical lateral cephalometric measurements were done manually. The results of this study showed a more accurate surgical prediction with the Simplant program. In group I (three-dimensional cephalometric measurement) there was not a statistically significant difference between the prediction measurements done before the surgery and those compared with the post-surgically result. In group II, (two-dimensional cephalometric measurements) on the surgical predictions done previously by hand using cut and paste mobiles taken from the patient’s Hospital records, we observed that in the SNA angle and the maxillary length measurements there was a statistically difference (p < .05). Therefore we conclude that the three-dimensional method is more accurate than the twodimensional method in planning surgical orthognatic procedures. Key words: Three-dimensional cephalometry, bi-dimensional cephalometry, craniofacial anomalies, cleft lip and palate, maxillary protrusion, mandibular pragmatism, orthognatic surgery.

Utilidad de la cefalometría tridimensional en el diagnóstico y plan de tratamiento ortodóncico-quirúrgico al compararlo con la cefalometría bidimensional en pacientes con anomalías craneofaciales

El objetivo del estudio fue comparar los resultados de la prediccion de la cefalometria tridimensional con la bidimensional en pacientes sometidos a cirugia ortognatica. El estudio involucro dos grupos de pacientes con anomalias craneofaciales de 15 a 30 anos de edad. Al grupo I correspondieron pacientes sometidos a cirugia ortognatica del periodo de abril del 2004 a enero del 2005. Se realizaron mediciones cefalometricas pre y posquirurgicas utilizando el programa Simplant (version CMF 8.2 de Materialise, NV, Belgium). Al grupo II correspondieron pacientes que ya habian sido sometidos a cirugia ortognatica del periodo de enero de 1999 a enero de 2004. Las mediciones cafalometricas se realizaron de forma manual y se tomaron de radiografias laterales de craneo pre y postquirurgicas. Los resultados de este estudio demostraron que existe mayor precision quirurgica al realizar la prediccion con el uso del programa Simplant, demostrando que en el grupo I (medicion cefalometrica tridimensional) no existieron diferencias estadisticamente signifi cativas entre las mediciones de la prediccion realizada antes de la cirugia al compararlas con el resultado postquirurgico. En el grupo II (medicion cefalometrica bidimensional), las predicciones quirurgicas ya realizadas con acetatos (moviles) de forma manual y tomadas de los expedientes clinicos, se observo que la medida del angulo SNA y de la longitud maxilar obtuvo una p < .05. En conclusion se demostro que la precision en la planeacion del tratamiento quirurgico por medio del metodo tridimensional (3D) es mejor que con el metodo bidimensional (2D). Palabras clave: Cefalometria tridimensional, cefalometria bidimensional, anomalias craneofaciales, secuelas de labio y paladar fi surado, retrusion maxilar, prognatismo mandibular, cirugia ortognatica.

Aparato preortopédico con pines utilizado en el alineamiento de los segmentos maxilares en pacientes con labio y paladar unilateral fisurado

Resumen Este articulo describe un aparato ortopedico con pines utilizado en el tratamiento prequirurgico para pacientes con labio y paladar unilateral completamente fisurado antes de la reparacion del labio. Este aparato fue disenado con el fin de corregir transversalmente los segmentos palatinos en la parte posterior, alinear el segmento menor en la parte anterior hacia la linea media facial y reducir la fisura cerca del labio para mejorar la forma del piso de la base nasal y evitar compensaciones quirurgicas posteriores de los tejidos blandos.

Use of the modified Latham appliance prior to cheiloplasty

Pre-surgical orthopedics is a treatment that modifi es the position of fi ssured maxillary segments. In children with Bilateral Cleft Lip and Palate (BCLP); the collapse of the maxillary segments and protrusion of the premaxilla imply that during the surgical procedure there may be an excessive tension and make cheilopasty diffi cult. A modification of the Latham’s Device (MLD) was performed to correct the position of the premaxilla and the palatal processes. The study was conducted with photographs and dental casts of 14 BCLP patients, 0 to 12 months old with a protruding premaxilla of more than10 mm. On a lateral view, the average reduction was 19.75 mm; in an occlusal view, the left side was reduced 15.15 mm and on the right side 13.87 mm. A signifi cant protrusion decrease was achieved. Key words: Pre-surgical orthopedics, modifi ed Latham appliance, bilateral cleft lip and palate.

Utilización del aparato de Latham modificado y utilizado previo a la queiloplastia

La ortopedia prequirurgica es el tratamiento que modifi ca la posicion de los segmentos maxilares fi surados. En ninos con labio y paladar hendido bilateral (LPHB) el colapso de los segmentos maxilares y la protrusion premaxilar implican una excesiva tension y difi culta la queiloplastia. Se realizo una modifi cacion al aparato de Latham para corregir la posicion de la premaxila y los procesos palatinos. El estudio se hizo en registros fotografi cos y modelos de estudio de 14 pacientes de 0 a 12 meses con LPHB con premaxilas protruidas de mas de 10 mm. La reduccion en promedio de la distancia en una vista lateral fue de 19.75 mm. En un vista oclusal del lado Izquierdo fue de 15.15 mm y del lado derecho de 13.87 mm, se logro una disminucion signifi cativa de la protrusion. Palabras clave: Ortopedia prequirurgica, aparato de Latham modifi cado, labio y paladar hendido bilateral.

Anteroposterior and vertical maxillary changes with facial mask use in patients with unilateral cleft lip palate sequelae from General Hospital «Dr. Manuel Gea González

Cleft lip and palate is a congenital malformation which can affect breathing, swallowing, language articulation, audition and voice. These patients show an insuffi cient maxillary growth and a class III skeletal malocclusion due to maxillary retrusion. Orthopedic treatment of the unilateral cleft lip and cleft palate patient by means of a facemask during the right time can stimulate maxillary growth. This study reviewed 90 clinical charts (pre and post treatment) of patients with complete unilateral cleft lip and cleft palate, treated from 1996 to 2007 with rapid palatal expansion through an occlusal acrylic plate and facemask at the Orthodontic Department, General Hospital «Dr. Manuel Gea Gonzalez» in Mexico City. To evaluate the sagittal and vertical maxillomandibular change the student’s T test, Wilcoxon test and χ2 test (SPSS v.10) were used. Our results show that the use of this appliance increases vertical dimension and reduces maxillomandibular discrepancy due to downward and forward growth of the maxilla. Key words: Cleft lip and palate, facemask.