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1.
Robrecht J. H. Logjes Ronald L. A. W. Bleys Corstiaan C. Breugem 《Clinical oral investigations》2016,20(5):895-901
Objective
Surgical techniques to obtain adequate soft palate repair in cleft palate patients elaborate on the muscle repair; however, there is little available information regarding the innervation of muscles. Improved insights into the innervation of the musculature will likely allow improvements in the repair of the cleft palate and subsequently decrease the incidence of velopharyngeal insufficiency. We performed a literature review focusing on recent advances in the understanding of soft palate muscle innervation.Material and methods
The Medline and Embase databases were searched for anatomical studies concerning the innervation of the soft palate.Results
Our literature review highlights the lack of accurate information about the innervation of the levator veli palatini and palatopharyngeus muscles. It is probable that the lesser palatine nerve and the pharyngeal plexus dually innervate the levator veli palatini and palatopharyngeus muscles. Nerves of the superior-extravelar part of the levator veli palatini and palatopharyngeus muscles enter the muscle form the lateral side. Subsequently, the lesser palatine nerve enters from the lateral side of the inferior-velar part of the levator veli palatini muscle. This knowledge could aid surgeons during reconstruction of the cleft musculature. The innervation of the tensor veli palatini muscle by a small branch of the mandibular nerve was confirmed in all studies.Conclusion
Both the levator veli palatini and palatopharyngeus muscles receive motor fibres from the accessory nerve (through the vagus nerve and the glossopharyngeal nerve) and also the lesser palatine nerve. A small branch of the mandibular nerve innervates the tensor veli palatini muscle.Clinical relevance
Knowledge about these nerves could aid the cleft surgeon to perform a more careful dissection of the lateral side of the musculature.2.
Ana López-Giménez Javier Silvestre-Rangil Francisco-Javier Silvestre Vanessa Paredes-Gallardo 《Oral Radiology》2018,34(2):127-135
Objective
The aim of this study was to evaluate and compare the craniofacial cephalometric morphologies among different cleft types in a Spanish population.Methods
A retrospective cross-sectional study was carried out on 212 patients. The patients were subdivided into four groups according to their cleft types: unilateral cleft lip and palate; bilateral cleft lip and palate; cleft lip; and cleft palate. Angular and linear cephalometric measurements were taken on lateral radiographs.Results
Unilateral cleft lip and palate was associated with a dolichofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Bilateral cleft lip and palate was associated with a mesofacial growth pattern, skeletal Class I with protruded maxillary position, and lingual incisor inclination. Cleft palate was associated with a mesofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Cleft lip was associated with a brachyfacial growth pattern, skeletal Class I with protruded maxillary position, lingual upper incisor inclination, and corrects lower incisor inclination. Significant correlations were observed between cleft types and their craniofacial cephalometric measurements.Conclusions
The present information can be used for the determination of orthodontic treatment and even future orthognathic surgery planning, a requirement in most cleft patients.3.
Background
In a 25-year retrospective review of 1976–2000, the postoperative course after cleft palate surgery and pharyngeal flap surgery in 87 children with Pierre Robin sequence was studied.Patients and methods
The study comprised 114 interventions with 87 primary palatoplasties; 17 patients required palatal fistulae repair and 10 children were treated with secondary pharyngoplasty procedures. All children were divided into three postnatal risk groups according to the severity of their symptoms at birth and in the course of the early months of life.Results
A direct correlation was seen between the incidence of early postnatal difficulties and the postoperative obstructive complications after cleft palate surgery and pharyngeal flap surgery. Thus, children experiencing obstructive problems at birth (high postnatal risk group) displayed more severe complications at the time after cleft palate repair. In children undergoing pharyngeal flap surgery not only early postoperative obstruction but also late obstructive sleep apnea can occur.4.
Niels Christian Pausch Karsten Winter Dirk Halama Christian Wirtz Vedat Yildirim Sirintawat Nattapong 《Oral and maxillofacial surgery》2016,20(1):19-26
Objective
The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected.Setting
The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, GermanyPatients and participants
Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped.Results
Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons’ attitudes.Conclusion
Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.5.
Susanne Sehhati-Chafai-Leuwer S?ren Wenzel Reinhard Bschorer Hartwig Seedorf Thomas Kucinski Hannes Maier Rudolf Leuwer 《Journal of cranio-maxillo-facial surgery》2006,34(6):351-354
OBJECTIVES: The impact of cranio-maxillofacial procedures upon Eustachian tube function is still largely unknown. The aim of this presentation is to depict new aspects of Eustachian tube function and to demonstrate its importance to cranio-maxillofacial surgery. METHODS: Two different groups of patients were examined both clinically and by MRI of the Eustachian tube region. One of these groups comprised 15 adult patients with a history of cleft palate; another consisted of 32 patients with a history of a so-called patulous Eustachian tube. RESULTS: Clinical and MRI-findings revealed that the problem of persistent chronic middle ear disease with cleft palate patients depends crucially on the integrity of the pterygoid hamulus and of the tensor veli palatini muscle after cleft palate repair. The masticatory muscles on the other hand also play an important role in Eustachian tube function in non-cleft patients. CONCLUSION: The maxillofacial surgeon should be aware that he holds a key position for preventing as well as treating Eustachian tube pathophysiology. 相似文献
6.
Kirti Chaudhry Dutt Sukhvinder Bindra Meenakshi Awana Manjit Talwar Gurvanit Lehl 《Journal of maxillofacial and oral surgery》2017,16(2):145-151
Introduction
Leiomyoma is a rare tumor of smooth muscle origin with a very low incidence in the maxillofacial region. Intraosseous occurrence of oral leiomyoma is even rare with involvement of mandible followed by maxilla.Aim
The purpose of this paper is to present a case of intraosseous leiomyoma of the left mandibular angle region with the review of literature describing this rare entity. The paper also highlights the need to include this entity in differential diagnoses of jaw lesions.Material and Method
An extensive search of literature was carried out on the Medline-Pubmed and Google Scholar database using the keywords leiomyoma, maxilla, mandible, oral and palate to thoroughly search and collect all the reported cases of intraosseous leiomyoma.Result
To the best of our knowledge till date only 22 cases of intraosseous leiomyoma have been reported in the maxillomandibular region we represent the 23rd case of the intraosseous leiomyoma in a 36 year old male patient.Conclusion
Though uncommon but it is known to occur in the jaws therefore intraosseous leiomyoma should be included in the list of differential diagnoses of radiolucent lesion of mandible and maxilla.7.
The high incidence of middle ear effusion in cleft lip and/or palate infants and children led to the development of a tension sling for the tensor veli palatini muscle for better Eustachian tube function after intravelar veloplasty.--The surgical technique is outlined in this paper and an audiometric examination was conducted to determine the influence of this surgical modification, performed in the same procedure as the intravelar veloplasty, on the Eustachian tube function. The intra- and intergroup comparisons indicate that this surgical technique has a positive influence on the tube function. 相似文献
8.
D F du Toit 《SADJ》2003,58(8):335-337
The auditory (Eustachian) tube connects the middle ear with the nasopharynx. This conduit permits equalisation of pressure between the middle ear and the throat. Balanced pressure allows the eardrum to vibrate freely as sound waves strike it. The auditory tube is also a potential anatomical route whereby opportunistic pathogens may migrate from the nose and throat to the middle ear. Eustachian tube (ET) function is disturbed in children with cleft palate, thereby rendering them susceptible to chronic otitis media with effusion (OME) and temporary conductive deafness. ET obstruction follows in these patients, and is thought to be related to the inability of the tensor veli palatini (TVP) to function properly. This anatomical overview reviews the clinical importance of the ET in the normal population and children with cleft palate. 相似文献
9.
10.
Santhosh Kumar Kuna N. Srinath B. S. Naveen Kamal Hasan 《Journal of maxillofacial and oral surgery》2016,15(2):221-228
Background
Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another. No one technique of cleft lip repair consistently produces ideal aesthetic and functional results.Objectives
This study was conducted to compare the outcomes attained using two different designs of skin incision used for surgical correction of unilateral cleft lip.Materials and Methods
Modified Millard’s incision and Delaire’s functional method techniques were performed and evaluated on 18 patients who received primary unilateral cleft lip repair. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid’s bow, lip length, and nostril symmetry and appearance of the alar dome and base. Chi-square and Fisher exact test, Student t test (two tailed, independent) and Student t test (two tailed, dependent) were used for statistical analysis of study parameters at 5 % level of significance.Results
Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. The outcome of our surgical methods was good and suggested quantitative changes with progressive diminution of asymmetry of the cleft and non cleft sides.Conclusion
Lip length improvement was better in case of modified Millard’s incision. The Delaire’s functional method of cleft lip repair results in improved nasal symmetry due to correction of the abnormal insertions of the underlying musculature.11.
Velupillai Ilankovan 《Journal of maxillofacial and oral surgery》2017,16(1):3-12
Introduction
Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance.Method
The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face.Results
Different face lift, neck lift procedures with innovative techniques are demonstrated.Conclusion
The aim is to provide an unoperated balanced facial proportion with zero complication.12.
Ashok Kumar Jena Vidya Rattan Satinder Pal Singh Ashok Kumar Utreja Singh Sombir 《Journal of maxillofacial and oral surgery》2016,15(1):12-17
Purpose
To test the hypothesis that there is no immediate and long-term effects of maxillary distraction osteogenesis (DO) on nasal index among adult subjects with cleft lip and palate deformities.Materials and Methods
Twelve adult subjects in the age range of 17–20 years with complete unilateral cleft lip and palate underwent advancement of maxilla by DO. The immediate and long-term effects of maxillary DO on nasal index were evaluated from extra-oral full face frontal photographs recorded prior to DO (T0), at the end of active DO (T1) and at least 2-years after the DO (T2). The ANOVA, Post Hoc test (Bonferroni) and Pearson correlation coefficients were used. The probability value (P value) 0.05 was considered as statistically significant.Results
SNM angle and Ptm-M distance increased significantly by DO (P < 0.001). The nasal index increased significantly (P < 0.01) by 13.85 % from T0 value of 85.15 ± 4.49 to 99.02 ± 11.16 % at the end of active distraction (T1) and by 12.69 to 97.84 ± 9.14 % at the end of long-term follow-up (T2). The correlation between sagittal maxillary advancement and nasal index was statistically significant (P < 0.001). For each millimeter of maxillary advancement, the nasal index increased by 1.38 % and 1.8 % at the end of active distraction and long-term follow-up respectively.Conclusion
The advancement of maxilla by distraction osteogenesis among subjects with cleft lip and palate deformities increased nasal index significantly.13.
The auditory tube, middle and inner ear, and paratubal musculature were removed en bloc at autopsy from a 1 month old white cleft palate female. The specimen was serially sectioned in a coronal plane and studied under light microscopy. Severe inflammatory changes were observed in the middle ear and osseous portion of the auditory tube in association with the presence of a middle ear effusion. While the posterior tubal lumen, tubal cartilage, and tensor veli palatini (TVP) and tensor tympani muscles were similar to those of an age-matched control specimen, the anterior tubal lumen was seen to be superoinferiorly abbreviated with a large intrusive malpositioned levator veli palatini (LVP) muscle occupying the inferior tubal floor. This muscle was noted to divide into two bundles on proceeding posteriorly with the more superior bundle taking an abnormal origin from the inferior surface of the tube. The luminal compression observed in this specimen is reminiscent of that previously described in cleft fetuses though the abnormal morphology of the LVP muscle has not been reported for the few cleft palate specimens studied. It is probable that this morphology is idiomatic to the present specimen and not a characteristic of the cleft palate condition. 相似文献
14.
Gerhard K. P. Bittermann Ad P. de Ruiter Nard G. Janssen Arnold J. N. Bittermann Aebele M. van der Molen Robert J. J. van Es Antoine J. W. P. Rosenberg R. Koole 《Clinical oral investigations》2016,20(2):207-217
Objective
In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.Materials and methods
A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.Results
Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.Conclusions
An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.Clinical relevance
The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.15.
Sanjay Roy Chowdhury K. Rajkumar Tushar Deshmukh 《Journal of maxillofacial and oral surgery》2017,16(1):96-100
Introduction
Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people.Materials and Methods
Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study.Results
This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management.Conclusion
Maxillary swing is a good approach for getting access to the deep pathologies like JNA.16.
Colonel Priya Jeyaraj 《Journal of maxillofacial and oral surgery》2018,17(2):175-181
Introduction
Despite the improvement in surgical techniques in cleft palate surgery, oronasal fistulas continue to remain a challenge, usually the result of residual palatal and alveolar clefts and post-palatoplasty defects. The tongue flap is an extremely versatile, sturdy, reliable and efficient means of closure of anterior as well as posterior, unilateral and bilateral palatal defects, effectively functionally obliterating the oronasal communication, owing much of its success to its highly vascular structure, good mobility, texture match, central location and low donor site morbidity. However, it has a few drawbacks. Flap dehiscence and detachment during the early postoperative period is a troublesome complication owing to tongue movements during normal activities such as speaking, swallowing, yawning and coughing.Aim
This article describes some of the methods which can be used to effectively alleviate these shortcomings.Methods
A protocol of immobilizing the tongue by tethering it to the maxillary teeth for the 3-week postoperative period, and also maintaining the patient on nasogastric feeding, until the patient is taken up for surgical separation the pedicle, was employed in all patients in this case series.Results
There was a successful and predictable take of the tongue flap at the donor site, namely the palatal/oronasal fistula with its successful closure, in all the patients.Conclusion
Treatment of the oronasal fistula using a two-layer closure using the nasal mucoperiosteum together with an anteriorly based dorsal tongue flap is an easy and efficient method, whose reliability can be further increased by avoiding a common complication, namely tongue flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also maintaining the patient on nasogastric feeding for the 3-week postoperative period.17.
Alijda J. Sabelis Mette A. R. Kuijpers Rania M. Nada Yu-Ting Chiu Ewald M. Bronkhorst Anne Marie Kuijpers-Jagtman Piotr S. Fudalej 《Clinical oral investigations》2016,20(5):943-950
Background
The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR) and palatal morphology (PM) in children with unilateral cleft lip and palate (UCLP). For this type of inter-center research, a scoring method that could be performed over the internet would be the most effective. Therefore, the aim of this study was to investigate the reliability of application of the EUROCRAN index on 3D digital models or photographs of plaster models instead of using plaster models.Methods
The EUROCRAN reference models were presented in three formats: plaster models, 2D photographs of plaster models, and 3D digital models. Plaster models of children with UCLP (n?=?45) were rated. Of each case, all three formats were rated by six calibrated observers in random order. The strength of agreement of the ratings was assessed with kappa statistics. Concordance among observers was evaluated with the intra-class correlation coefficient (ICC).Results
The ICC showed a good inter-observer agreement for the DAR and poor inter-observer agreement for the PM. Intra-observer agreement for the DAR was moderate to very good, yet for the PM poor to moderate. Comparison between the three formats per observer for the DAR was good or very good and for the PM moderate to poor.Conclusions
The overall results show that the EUROCRAN index is an acceptable and reliable scoring method for the DAR on plaster models, 2D photographs of plaster models, and 3D digital models. However, due to the small range of deviations in palatal morphology between the cases in our study, the PM component of the index was difficult to assess.Clinical relevance
In clinical audits and inter-center studies, plaster models can be substituted by 2D photographs of plaster casts or 3D digital models when grading treatment outcome with the EUROCRAN index.18.
K. Mustafa Fatima Shehzana H. Hari Kishore Bhat 《Journal of maxillofacial and oral surgery》2016,15(4):528-534
Objectives
To prospectively analyze the amount of alar flare, factors contributing to alar flare and efficacy of cinch suture as an adjunctive procedure for alar flare reduction.Study Design
Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each. Alar cinch was performed as an adjunct procedure in group 2 patients and results were compared to group 1 which was the control group. Measurements were made on the patients and on 1:1 standardized photographs.Results
Group 2 showed a near pre-operative alar position compared to group 1. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1.Conclusion
Alar cinch suture restores the normal alar width by preventing the lateral drift of the naso-labial muscle and thereby reducing the postoperative nasal flare significantly.19.
Sven Holger Baum Gunnar Rieger Roman Pförtner Christopher Mohr 《Oral and maxillofacial surgery》2017,21(4):409-418
Purpose
Whistle deformities are frequent sequelae after surgical correction of cleft lip, trauma, or tumor excision. The aim of this study was to examine the role of autologous free fat grafting in the reconstruction of whistle deformity.Patients
Fifteen patients with whistle deformity were enrolled in this pilot study. The mean follow-up period was 19 months. Liposuction was done followed by the replantation of an average of 2.2 ml autologous fat per patient (range 0.7–4 ml). An overcorrection was performed in all patients.Results
All the patients showed improvements in whistle deformity. The mean resorption rate was 53% (range 30–80%). Three patients (20%) were not satisfied with the postoperative result. Six complications were assessed (4× feeling of pressure [27%], one hematoma [7%], one recurrent pain [7%]), but a major complication did not occur.Review
We also present a review of the literature with different techniques that were described in the last 20 years.Conclusion
Autologous free fat graftings for reconstruction of whistle deformity represent a reliable method with a low complication rate. However, the resorption rate is unpredictable. If necessary, several autologous fat transplantations should be conducted at an interval of at least 6 months.20.