Segmental Cleft-orthognathic Surgery to Achieve Facial Balance, Fistula Closure, and Arch Unification.
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ABSTRACT:
SUBMITTER: Parsaei Y
PROVIDER: S-EPMC8782101 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Publications
Segmental Cleft-orthognathic Surgery to Achieve Facial Balance, Fistula Closure, and Arch Unification.
Parsaei Yassmin Y Maniskas Seija S Reategui Alvaro A Lopez Joseph J Steinbacher Derek D
Plastic and reconstructive surgery. Global open 20220121 1
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Project description:Computer-assisted 3D planning has overcome the limitations of conventional 2D planning-guided orthognathic surgery (OGS), but difference for facial contour asymmetry outcome has not been verified to date. This comparative study assessed the facial contour asymmetry outcome of consecutive patients with unilateral cleft lip and palate who underwent 2D planning (n = 37)- or 3D simulation (n = 38)-guided OGS treatment for correction of maxillary hypoplasia and skeletal Class III malocclusion between 2010 and 2018. Normal age-, gender-, and ethnicity-matched individuals (n = 60) were enrolled for comparative analyses. 2D (n = 60, with 30 images for each group) and 3D (n = 43, with 18 and 25 images for 2D planning and 3D simulation groups, respectively) photogrammetric-based facial contour asymmetry-related measurements were collected from patients and normal individuals. The facial asymmetry was further verified by using subjective perception of a panel composed of 6 blinded raters. On average, the facial contour asymmetry was significantly (all p < 0.05) reduced after 3D virtual surgery planning for all tested parameters, with no significant differences between post-OGS 3D simulation-related values and normal individuals. No significant differences were observed for pre- and post-OGS values in conventional 2D planning-based treatment, with significant (all p < 0.05) differences for all normal individuals-related comparisons. This study suggests that 3D planning presents superior facial contour asymmetry outcome than 2D planning.
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Project description:ObjectivesAberrant facial growth in individuals affected by orofacial clefts can result in maxillary retrusion and class III malocclusion, with a proportion requiring surgical correction at cessation of growth. This study aimed to evaluate occlusal and cephalometric outcomes of combined orthodontic-orthognathic treatment.Material and methodsRetrospective cohort study in a United Kingdom cleft center. Participants included twenty-seven patients (20 males, 7 females) with cleft (n = 16 UCLP :7 BCLP :4 ICP) who consecutively underwent combined surgical treatment for Class III malocclusion between January 2013 and December 2017. Records were collected pre-treatment (T0), pre-surgery (T1) and at debond (T2). Models were scored using the Peer Assessment Rating (PAR) index and cephalometric radiographs were traced and analyzed. Outcomes were assessed by an independent rater.ResultsMean age at surgery was 21.4 years (SD 4.9). Le Fort 1 advancement (mean 6.1 mm, SD 4.0) was performed in all cases. Additional procedures included mandibular setback (n = 2), cortico-cancellous bone grafting (n = 6) and genioplasty (n = 1). Mean T0 PAR score was 44.8 (SD 11.7), reducing to 3.6 (SD 2.0) at T2, indicating a mean % PAR score reduction of 91.6% (SD 4.7). Class III skeletal profiles improved from a mean T0 ANB of -2.1º (SD 2.2), to 2.8º (SD 1.6) at T2. Mean T0 overjet was -3.3 mm (SD 2.3), increasing to 2.6 mm (SD 1.3) at T2.ConclusionCleft orthognathic surgery differs in complexity and approach to routine orthognathics, however, these results demonstrate that occlusal outcomes can still be comparable with non-cleft populations. Outcome data can be used for comparison with other centers providing cleft orthognathic treatment.
| S-EPMC11534636 | biostudies-literature
Project description:A concave profile with class III malocclusion is most often due to a combination of maxillary hypoplasia and mandibular hyperplasia. Surgical correction entails normalization of jaw positions and is more challenging in the setting of concurrent asymmetry and open bite. Treatment should optimize both facial harmony and occlusion. Orthognathic surgery for class III deformities occurs at skeletal maturity and should address all aspects of the condition while preventing unnecessary emotional stress from delayed treatment. In this article, the authors describe the 3-jaw orthognathic surgery technique to address maxillary hypoplasia, mandibular prognathism, open bite, and mandibular asymmetry in a single procedure. The process of preoperative 3-dimensional (3D) virtual surgical planning, detailed surgical technique, fat grafting, and a comparison of preoperative and postoperative 3D aesthetic outcomes is presented. Additionally, a retrospective review of postoperative outcomes of 54 patients who received 3-jaw orthognathic surgery is presented as well.
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Project description:PurposeThe purpose of this study was to determine the facial movement characteristics of patients who underwent orthognathic surgery. The specific aims were to determine the presurgery versus postsurgery differences in facial movements; to determine whether the presurgery facial movements were similar among patients with different dentofacial deformities; and to determine whether patients have a more similar post- than presurgery dentofacial morphology and soft tissue movement. The hypothesis was that there are differences between the pre- and postsurgery facial movements.Patients and methodsThe sample consisted of 19 patients (11 women, 8 men) with a mean age of 20.6 years (SD +/- 8.34). Facial movement and lateral cephalometric data were collected at presurgery, and at 6 and 12 months postsurgery. Measures of the facial skeletal differences were made from lateral cephalometric radiographs and facial movements were recorded by a video-based tracking system. Descriptive and inferential statistics were performed on principal component scores generated from the movement data. A linear mixed-effects model was used to test for significant differences in movement.ResultsDifferences were found between the presurgery and 12-month postsurgery visits for the instructed smile, lip purse, eye closure, grimace, and mouth opening movements as well as the natural smile. Also, there were significant differences at presurgery among the dentofacial groups for the lip purse movement but no differences were found at postsurgery for any of the movements.ConclusionThese findings suggest that facial movements are effected by skeletal malocclusion and orthognathic surgical procedures.
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Project description:Esophageal fistulas in the cervical region are usually difficult to manage and carry a high morbidity. We report a case of an esophago-colonic fistula after colonic interposition, successfully managed with vacuum-assisted closure 'V.A.C. system', (Kinetic Concepts Inc., San Antonio, TX, USA). The patient initially presented with purulent fluid from the cervical wound 13 days after surgery. Esophagogram confirmed a leak. Since the patient had a history of anastomotic leaks, a surgical intervention was not the treatment of choice. In light of this, conservative treatment with V.A.C. system was initiated. She underwent full recovery.
| S-EPMC5755238 | biostudies-literature
Project description:Introduction: The pharyngeal arches are transient developmental structures that, in vertebrates, give rise to tissues of the head and neck. A critical process underlying the specification of distinct arch derivatives is segmentation of the arches along the anterior-posterior axis. Formation of ectodermal-endodermal interfaces is a key mediator of this process, and although it is essential, mechanisms regulating the establishment of these interfaces vary between pouches and between taxa. Methods: Here, we focus on the patterning and morphogenesis of epithelia associated with the first pharyngeal arch, the first pharyngeal pouch (pp1) and the first pharyngeal cleft (pc1), and the role of Fgf8 dosage in these processes in the mouse model system. Results: We find that severe reductions of Fgf8 levels disrupt both pp1 and pc1 development. Notably, out-pocketing of pp1 is largely robust to Fgf8 reductions, however, pp1 extension along the proximal-distal axis fails when Fgf8 is low. Our data indicate that Fgf8 is required for specification of regional identity in both pp1 and pc1, for localized changes in cell polarity, and for elongation and extension of both pp1 and pc1. Discussion: Based on Fgf8-mediated changes in tissue relationships between pp1 and pc1, we hypothesize that extension of pp1 requires physical interaction with pc1. Overall, our data indicate a critical role for the lateral surface ectoderm in segmentation of the first pharyngeal arch that has previously been under-appreciated.
| S-EPMC10242020 | biostudies-literature
Project description:Facial photographs of the subjects are often used in the diagnosis process of orthognathic surgery. The aim of this study was to determine whether convolutional neural networks (CNNs) can judge soft tissue profiles requiring orthognathic surgery using facial photographs alone. 822 subjects with dentofacial dysmorphosis and / or malocclusion were included. Facial photographs of front and right side were taken from all patients. Subjects who did not need orthognathic surgery were classified as Group I (411 subjects). Group II (411 subjects) was set up for cases requiring surgery. CNNs of VGG19 was used for machine learning. 366 of the total 410 data were correctly classified, yielding 89.3% accuracy. The values of accuracy, precision, recall, and F1 scores were 0.893, 0.912, 0.867, and 0.889, respectively. As a result of this study, it was found that CNNs can judge soft tissue profiles requiring orthognathic surgery relatively accurately with the photographs alone.
| S-EPMC7529761 | biostudies-literature
Project description:IntroductionA bronchopleural fistula (BPF) after an anatomical lung resection commonly arises singly. We report a case of a metachronous BPF, which developed after omentoplasty of a preceding fistula and subsequently closed without any intervention.Case presentationA 77-year-old patient underwent omentoplasty for a brochopleural fistula (BPF) following a right lower lobectomy. A sudden massive air leak developed from the novel BPF approximately 1 cm proximal to the preceding fistula 3 days later. The air leak resolved spontaneously without any intervention one week later. The corresponding fistula was found to be completely closed. Computed tomography showed the omental flap covered both fistulae.ConclusionThe present case suggested that a metachronous BPF could develop and a harvested omental flap might migrate even after being anchored.
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