Dento-skeletal study in J. Delaire's architectural and structural analysis. A complement adapted to orthodontic practice

Dento-skeletal analysis complete the architectural and structural analysis allowing to give precise details about: The dimensions and situations anomalies of maxillary and mandible, directly showing chances of succeeding the treatment. The nature and amplitude of orthopedics and/or orthodontics movements to effect. The control in the end of treatment to see if the tests required for treatment durability are respected. It facilitates the dialogue between the surgeon and the orthodontist in surgico-orthopedic cases.     

The craniofacial architectural factors predisposing to a skeletal Class II identified by Jean Delaire's architectural analysis

The current state-of-the-art medical practice involves considering treatment both in terms of symptomatology and etiology. In the case of dento-facial deformities, treatment and prognosis must deal both with constitutional and functional anomalies. Most accurate diagnosis can be achieved using Jean Delaire's architectural cephalometric analysis. We illustrate the usefulness of this system using examples of class II skeletal malocclusions. Class II cranial malocclusion factors appear to be difficult to treat successfully. Maxillary and mandibular functional and constitutional anomalies are described. Functional deformities such as anterior rotation of the maxilla or posterior rotation of the mandibular ramus, can be successfully treated with early orthopedic care. Constitutional anomalies, such as excess length of the premaxilla or maxillary vertical excess, should frequently be treated in a combined orthodontic-surgical sequence as orthopedic care alone is ineffective. This explains the usefulness of Jean Delaire's architectural approach to obtain stable results in the treatment of maxillo-mandibular deformities.     

The C0 line: from Delaire's analysis of craniofacial structure to modeling it on a computer spreadsheet

BACKGROUND: We developed a computer spreadsheet allowing mathematical modelization of Delaire's craniofacial architecture analysis. METHOD: An orthonormed drawing field was defined from the classical C1 line and the new C0 line. The cartesian coordinates defined anatomic points in this orthonormed field. Lines were drawn from the coordinate equations defined on the basis of the laws of plane geometry. These formulae were then entered into the spreadsheet. RESULTS: The spreadsheet automatically calculates the line equations, the angles separating these lines, and the coordinates of the constructed points, in the defined orthonormed field. This calculation is achieved using the coordinates of the user-measured anatomic points. A new order in line drawing allows simplification of manual drawing. DISCUSSION: We present the advantages and inconveniences of this new method which does not modify the final drawing result nor the interpretation of Delaire's analysis.     

Delaire's cheilorhinoplasty: unilateral cleft aesthetic outcome scored according to the EUROCLEFT guidelines

OBJECTIVE: The aim of our study is to evaluate, in accordance with EUROCLEFT guidelines, the aesthetics of nasolabial area in a sample of complete unilateral cleft of lip and palate patients (UCLP), after surgical correction with Delaire' technique. METHODS: Twenty-two UCLP patients (16 males and 6 females, 9 right and 13 left side clefts) were enrolled in this retrospective study. Patients were operated at 7 (mean value) months of age by a single surgeon. Frontal and sub-mental photos for each baby were recorded at 8.5 (mean value) years of age, and evaluated twice, by three independent maxillofacial surgeons. A five-point scale (EUROCLEFT guidelines) was used. Nonparametric analysis (Kruskal-Wallis test) was applied to detect differences in medians obtained in studied groups. RESULTS: Kruskal-Wallis test showed no statistical significant differences among evaluations of three surgeons and between the first and the second evaluation of the same surgeon. The global appearance of the upper lip and nose was scored with a mean value of 2 (i.e. good). The sample was then divided into two subgroups, according with patient' age; the aesthetics and the symmetry of the nose resulted better in elder patients (i.e. subgroup A, mean period of observation=10.2 years), whereas upper lip achieved better results in younger patients (i.e. subgroup B, mean period of observation=4.9 years). CONCLUSIONS: EUROCLEFT guidelines are a useful method to evaluate--aesthetically and over time--cleft lip and palate patients, treated with a single surgical procedure. We hypothesize that Delaire technique could progressively improve aesthetics and symmetry of the nose, throughout the growth of the patient.     

Phonetic results in a series of 10 pharyngoplasties using Delaire's technic

Specific features of Delaire's operation when compared with Rosenthal's inferior pedicle pharyngoplasty are described, and phonetic results obtained in a recent series of 10 patients operated upon using the former procedure reported. The excellence of these results is emphasized.     

Rhinoplasty and computerized cephalometry. Subcutaneous tissue and bony landmarks

We describe a computerised cephalometric method which allows ideal positioning of the tip of the nose and chin (bone and skin) for use when rhinoplasty is planned.     

Procedure to follow after postero-anterior traction with Delaire's orthopedic mask in the treatment of class III lesions

The "Fonctionnal Lingual Elevator" changes the lingual situation and dynamic. The tongue becomes in a higher and forwards situation. This new situation generates biomécanics modifications of the labio-lingual and lingual pharyngal complex which induce secondary structural modifications.     

Uvulopalatopharyngoplasty for the obstructive sleep apnoea syndrome: value of polysomnography,Mueller manoeuvre and cephalometry in predicting surgical outcome

Sixty consecutive patients with the obstructive sleep apnoea syndrome (53 men and seven women) were analysed by questionnaire, polysomnography, röntgenographic cephalometry and the Mueller manoeuvre before and 6 months after uvulopalatopharyngoplasty (UPPP), to assess the surgical outcome and the prognostic value of preoperative evaluation. Seventy-three per cent of patients reported improvement of snoring and 55% reported improvement of excessive daytime sleepiness. Thirty-five per cent showed a decrease of at least 50% in the desaturation index, and 13% had a postoperative desaturation index below 5. Although the improvement of desaturation parameters was marked in some patients, the overall change was not significant. Neither the Body Mass Index (BMI), nor any of the cephalometric variables were significantly correlated to surgical outcome. Increased difference in collapsibility between the soft palate and the base of the tongue showed a close to significant relation with the improvement of desaturation index. High desaturation index, low mean saturation and deep lowest saturation were found to be slightly predictive of improvement in nocturnal desaturation. In a multivariate analysis however no significant predictors could be identified. It is concluded that UPPP is effective in reducing snoring and daytime sleepiness over a 6-month follow-up period, but that the overall improvement in nocturnal desaturation is limited and difficult to predict. Further research is needed to evaluate the long-term efficacy of UPPP.     

The architectural balance of the face: a 3D cephalometric concept]

The use of the c2000 software led us to develop a new 3D cephalometric construction, based on the selection on the axial CT Scans of 8 anatomical landmarks and of teeth, all of which were situated along the trigeminal neuro matriciel facial growth axes. The analysis of this construction is based on the use of an original mathematical tool in biology: the axes of inertia. Using the selection of both mental foramen, both infra and supra orbital foramen and the head of both malleus, the C 2000 software creates a geometrical construction called: "the maxillo-facial frame", as well as, a 3D cephalometric analysis: angles, distances, areas, volumes center of gravity and axes of inertia. Using the selection of teeth, the C 2000 software calculates the axes of inertia of each tooth or of groups of teeth. The use of the axes of inertia allow us to create of a hierarchy of anatomical levels the teeth, the half arches, the arches, both arches and the maxillo-facial frame. In addition, for each of these anatomical levels, the axes of inertia create a 3D landmark which allows the calculation of the orientation of each of these elements in relation to the others. The study of 28 orthomorphic people using this analysis revealed the existence of a maxillo-facial balance that is unique for each individual.     

Phenol anesthesia of the tympanic membrane in purulent otitis media: a structural analysis in the rat

Summary In the present study, local anesthetics were applied to the tympanic membrane (TM) of rats following experimentally evoked purulent otitis media (POM). The structure of the TM was evaluated 24 h, 2 weeks and 3 months after application of phenol to a discrete are of the right TM. The left ear was used as a control. POM induced swelling of all tissue layers of the pears tensa. The tissues were invaded by inflammatory cells and disintegrated. The fibrous layer also dissolved, leaving spontaneous perforations. However, phenol on inflamed TMs did not further alter the TM structure. These findings infer that the injurious effect of topical anesthesia on the intact TM is more or less negligible when applied to diseased TMs.     

The posterior glottis: structural and clinical considerations

Despite the presence of a number of good publications during the past two decades, the posterior glottis (PG) is still not clearly appreciated in clinical laryngological practice. This study focuses on searching the literature to find out the present day awareness of the PG, as well as highlighting some of its clinical features. The investigation proceeds with two main sections: (1) critical analysis of the literature on the PG during the last 50?years (2) describing the clinical appearance and behavior of the PG in 100 normal subjects. Results of section?1 illustrate the limited awareness in the literature of the existence of PG as a distinct part of the human larynx. Results of section?2 illustrate some misconcepts related to the PG as inter-arytenoid pachydermia, change of voice with lesions in the PG. Discussion elaborates on the significance of the findings and attempts to clarify certain misconcepts about the PG, its structure, function, and clinical features. In the light of the data collected from the literature regarding the dimensions of the PG, a set of recommendations were proposed regarding the optimal sizes of the endotracheal tubes in both sexes.     

Utilization of fresh human tympanic membranes for structural analysis and cytokeratin immunocytochemistry implementing resin techniques

CONCLUSIONS: The results of this study have demonstrated for the first time that tympanic membrane (TM) structure is preserved following removal of fresh, normal tissue from patients undergoing surgery. Greater clarity has been demonstrated using resin sections than in previous studies on paraffin sections. Of particular note, cytokeratin (CK) immunocytochemistry was successfully performed on resin sections, which has not been previously reported. This may have potential applications for future work involving tissues that express CKs. OBJECTIVES: To analyse the structure of normal, fresh human TM specimens after surgical removal and to evaluate their CK immunocytochemistry using resin techniques, neither of which have been demonstrated previously. MATERIAL AND METHODS: Seven TM specimens were removed during surgery and then preserved in a modified Karnovsky's fixative. Semi-thin and thin sections were examined by means of light and electron microscopy, respectively. For comparison purposes, paraffin block-embedded specimens were also sectioned. CK immunocytochemistry was performed on semi-thin sections using standard immunoperoxidase techniques, with expression being demonstrated using light microscopy. RESULTS: The three-layer architecture of the TM was preserved. The morphology of the TM was vastly superior in the semi-thin resin sections than in the thicker paraffin sections. The outer, middle and inner layers were clearly demonstrated. The integrity of the outer epithelial layer was maintained, with an outer keratinizing stratum corneum and underlying stratum granulosum, stratum spinosum and stratum basale layers resting on the basal lamina. The thin inner mucosal layer was also viable, consisting of simple squamous or cuboidal cells. Preservation of the middle lamina propria was achieved, with demonstration of the outer radial and inner circular fibres. CK immunocytochemistry utilizing resin techniques provided excellent staining of CK 7 and 8 in the inner layer, with positive staining of CK 5 and 10 in the outer layer.     

鼻内镜下重塑鼻腔结构治疗鼻腔结构异常临床分析

目的探讨鼻内镜手术治疗鼻腔结构异常的疗效。方法我科2008年1月-2012年11月在鼻内镜下对78例鼻腔结构异常患者施行手术治疗。结果所有患者随访6个月以上,均取得明显疗效,无并发症发生。治愈63例,有效12例,无效3例,总有效率96．1％。结论通过鼻内镜手术重塑鼻腔结构治疗鼻腔多结构异常是一种值得推荐的方法,根据患者具体病情实行个体化手术治疗可获得良好的临床效果。手术应以纠正鼻腔结构异常、调整两侧气流的对称性分布为主,以维系正常通气功能。     

The cochlear aqueduct: structural considerations.

Perusing 170 series of temporal bone sections, the course of the aqueduct was found to be a spindle shape, based on numerous dilatations in the middle section. Ample space was offered for development of bony excrescences such as exostotic depositions and osteoma-like protrusions of all sizes. These added considerably to the difficulties of a free passage through the aqueduct.