Growth pattern tendency according to cleft type
Seo YJ, Park JW, Kim YH, Baek SH. Initial growth pattern of children with cleft before alveolar bone graft stage according to cleft type. Angle Orthod 2011;81:1103-10
Growth patterns of cleft patients are influenced by cleft type, scar tissue, treatment, and alveolar bone graft. The purpose of this study was to investigate the differences in initial growth patterns before alveolar bone grafting among unilateral cleft lip/alveolus (UCLA), unilateral cleft lip/palate (UCLP), and cleft hard palate (CP) patients who had undergone lip or palate surgery. This retrospective study included the UCLA group (n = 38), UCLP group (n = 38), and CP group (n = 28). The patients were of similar ages and treated with the same surgical techniques by the same surgeon. Lateral cephalograms were recorded 1 month before alveolar bone grafting in the UCLA and UCLP patients and before the start of orthodontic treatment in the CP group. Eighteen cephalometric landmarks and 29 skeletal and dental variables were used. The CP group showed the highest tendency for Class III relationships, followed by the UCLP group. The UCLA group had a similar maxillary position to the Korean norms. Impairment in the patients with CP and UCLP showed more posterior positioning of the maxilla and more hyperdivergent patterns compared with the UCLA group. The authors suggested that palatal scarring influences maxillary impairment more than lip scarring and concluded that when the degree of clefting increases from the primary palate (UCLA) to the secondary palate (CP or UCLP), there is a greater chance of a Class III relationship and a hyperdivergent pattern. This concept is important when diagnosing and predicting initial growth patterns according to cleft type.
Reviewed by David Servello
Orbital changes after LeFort III advancement in syndromic craniosynostosis
Nout E, van Bezooijen JS, Koudstaal MJ, Veenland JF, Hop WC, Wolvius EB, et al. Orbital change following Le Fort III advancement in syndromic craniosynostosis: quantitative evaluation of orbital volume, infra-orbital rim and globe position. J Craniomaxillofac Surg 2011 Jul 11 [Epub ahead of print]
Maxillary hypoplasia often contributes to shallow orbits and therefore a decrease in orbital volume. Severe complications of the eye can arise if the volume of the globe is compromised, including exposure keratitis, mechanical lagophthalmos, corneal ulcers, risk of impaired vision, and ultimately loss of the eye. Between 2003 and 2009, 18 patients were treated surgically with the LeFort III advancement distraction procedure. These patients included those with Crouzon’s disease and Apert’s and Pfeiffer’s syndromes. The average age of these patients was 14.7 years. Preoperative and postoperative computed tomography scans were available for analysis of the orbits. The scans were sliced, and the boundaries of the orbits were manually outlined, creating a left and right orbital mask on both the pretreatment and posttreatment sagittal slices. The same software was used to measure the infraorbital rim and globe movement. Postoperatively, the left and right orbital volumes increased significantly: 27.2% and 28.4%, respectively. There was also a significant difference between the preoperative and postoperative positions of the globes relative to the anterior infraorbital rim. The LeFort III advancement procedure is indicated for patients with compromised orbital support. Preoperatively, the globe was situated anteriorly to the infraorbital rim; postoperatively, it was positioned more posteriorly to the infraorbital rim. The globe position remained unaffected in the anteroposterior position, although the infraorbital rim moved forward. The authors emphasized the need for thinner computed tomography scan slices to enhance accuracy. In the future, visualizing soft-tissue and skeletal changes by using a 3-dimensional analysis will help with treatment planning and diagnosis, and enhance the evaluation of the LeFort III movement postoperatively.
Reviewed by Diana Weber
Orbital changes after LeFort III advancement in syndromic craniosynostosis
Nout E, van Bezooijen JS, Koudstaal MJ, Veenland JF, Hop WC, Wolvius EB, et al. Orbital change following Le Fort III advancement in syndromic craniosynostosis: quantitative evaluation of orbital volume, infra-orbital rim and globe position. J Craniomaxillofac Surg 2011 Jul 11 [Epub ahead of print]
Maxillary hypoplasia often contributes to shallow orbits and therefore a decrease in orbital volume. Severe complications of the eye can arise if the volume of the globe is compromised, including exposure keratitis, mechanical lagophthalmos, corneal ulcers, risk of impaired vision, and ultimately loss of the eye. Between 2003 and 2009, 18 patients were treated surgically with the LeFort III advancement distraction procedure. These patients included those with Crouzon’s disease and Apert’s and Pfeiffer’s syndromes. The average age of these patients was 14.7 years. Preoperative and postoperative computed tomography scans were available for analysis of the orbits. The scans were sliced, and the boundaries of the orbits were manually outlined, creating a left and right orbital mask on both the pretreatment and posttreatment sagittal slices. The same software was used to measure the infraorbital rim and globe movement. Postoperatively, the left and right orbital volumes increased significantly: 27.2% and 28.4%, respectively. There was also a significant difference between the preoperative and postoperative positions of the globes relative to the anterior infraorbital rim. The LeFort III advancement procedure is indicated for patients with compromised orbital support. Preoperatively, the globe was situated anteriorly to the infraorbital rim; postoperatively, it was positioned more posteriorly to the infraorbital rim. The globe position remained unaffected in the anteroposterior position, although the infraorbital rim moved forward. The authors emphasized the need for thinner computed tomography scan slices to enhance accuracy. In the future, visualizing soft-tissue and skeletal changes by using a 3-dimensional analysis will help with treatment planning and diagnosis, and enhance the evaluation of the LeFort III movement postoperatively.
Reviewed by Diana Weber
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