Treatment Of Craniofacial Deformities Research Articles

Main approaches of three-dimensional (3D) imaging examinations in the assessment, treatment, and follow-up of patients with skeletal Class III: a concise systematic review

Introduction: Class III malocclusion presents with several skeletal and dental factors, highlighting the large or protruding jaw, retrusive maxilla, protrusive mandibular dentition, retrusive maxillary dentition, or combinations. The importance of evaluating class III malocclusions, as well as their treatments, through three-dimensional (3D) images are highlighted. Objective: To present a concise systematic review of the approach of 3D imaging exams to conduct class III malocclusion treatments, as well as to follow up after orthognathic surgery. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 105 articles was found involving class III malocclusion and ortho-surgical treatments guided by three-dimensional (3D) images. A total of 44 articles were fully evaluated and 16 were included and discussed in this study. Positional, structural, and volumetric condylar changes after orthognathic surgery in skeletal Class III patients have been well elucidated using cone-beam computed tomography. In addition, the virtual surgical planning and the surgical splint manufactured in CAD/CAM facilitate treatment planning and offer an accurate surgical result in orthognathic surgery. The application of pre-engineered bone guidance splints allows the treatment of craniofacial deformities with precision. Therefore, the three-dimensional (3D) tool allows for the accuracy of treatments and planning of orthognathic surgery, as well as the best postoperative follow-up.

Fronto-orbito-nasal advancement a surgical approach based on skull development in treatment of craniofacial deformities

The classical treatment of craniosynostosis is based on the fundamental work by Tessier. However, developmental aspects suggest modified osteotomy lines like fronto orbito nasal advancement combined with a modified midfacial distraction. This also makes it possible to take assess the different distances of the anterior displacement of the individual parts of the skull. Pioneering in therapy is less the syndrome itself than the accompanying symptoms such as respiration and intracranial pressure. For brain release we recommended (Joos 1998) the osteoclastic procedure according to Powiertowsky (1974) within the first 6 months of life. For further treatment frontoorbito–nasal advancement and modified midface distraction seem to achieve better results in enlarging the inner nose and a more harmonious profile.

The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities.

Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go). All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3°±11.1 to 121.3°±2.9, and the mandibular width was improved from 117.5mm±6.8 to 111.9mm±4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56°±0.22, 0.65°±0.3 and 0.49mm±0.43, respectively. The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-dimensional planning in craniomaxillofacial surgery.

Introduction:Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results.Materials and Methods:We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients’ outcomes.Conclusions:3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.

Stem Cell Therapy for Craniofacial Bone Regeneration: A Randomized, Controlled Feasibility Trial

Stem cell therapy offers potential in the regeneration of craniofacial bone defects; however, it has not been studied clinically. Tissue repair cells (TRCs) isolated from bone marrow represent a mixed stem and progenitor population enriched in CD90- and CD14-positive cells. In this phase I/II, randomized, controlled feasibility trial, we investigated TRC cell therapy to reconstruct localized craniofacial bone defects. Twenty-four patients requiring localized reconstruction of jawbone defects participated in this longitudinal trial. For regenerative therapy, patients were randomized to receive either guided bone regeneration (GBR) or TRC transplantation. At 6 or 12 weeks following treatment, clinical and radiographic assessments of bone repair were performed. Bone biopsies were harvested and underwent quantitative micro-computed tomographic (μCT) and bone histomorphometric analyses. Oral implants were installed, subsequently restored, and functionally loaded with tooth restorations. Reconstructed sites were assessed for 1 year following therapy. No study-related, serious adverse events were reported. Following therapy, clinical, radiographic, tomographic, and histological measures demonstrated that TRC therapy accelerated alveolar bone regeneration compared to GBR therapy. Additionally, TRC treatment significantly reduced the need for secondary bone grafting at the time of oral implant placement with a five fold decrease in implant bony dehiscence exposure (residual bone defects) as compared to GBR-treated sites(p < 0.01). Transplantation of TRCs for treatment of alveolar bone defects appears safe and accelerates bone regeneration, enabling jawbone reconstruction with oral implants. The results from this trial support expanded studies of TRC therapy in the treatment of craniofacial deformities (ClinicalTrials.gov number CT00755911).

Evaluating aesthetics of the nasolabial region in children with cleft lip and palate: professional analysis and patient satisfaction

Cleft lip and palate is one of the most common deformities of the craniofacial region, and treatment of this deformity is essential for social reintegration. One of the major goals of surgery and treatment of craniofacial deformities is to improve the aesthetic appearance of the face, and thereby improve the patient’s social acceptability. Here, we present a critical review of the criteria for aesthetic evaluation of the nasolabial region in cleft patients by assessing publications with the highest level of evidence, including professional evaluation, and patient satisfaction. The findings indicate treatment of this condition represents a major challenge for multidisciplinary team care.

Preliminary Experience With a Dynamic Resorbable Fixation Device for Craniosynostosis Surgery

The advent of resorbable osteosynthesis material has revolutionized craniomaxillofacial surgery. The need to provide rigid bony fixation in the surgical treatment of craniofacial deformities has inspired an ongoing evolution of surgical innovations and implants. Stability of the plates has been improved, but the duration of their stability remains an ongoing problem. In infant craniofacial fixation, it is important to provide initial stability, but after 4 to 6 weeks, this is no longer required as the brain is rapidly expanding. Surgery was performed on 10 patients with sagittal suture synostosis with conventional suture resection, remodeling, and fixation with resorbable miniplate (PolyMax-RAPID) struts held in position with modeled resorbable pockets affixed to the neurocranium with resorbable screws placed across the resected suture between June 2004 and September 2008. All the patients presented a satisfactory aesthetic result without complications after at least 1-year follow-up. We present a further innovative method of craniofacial fixation in infants using resorbable plates as floating struts providing stability and at the same time controlled dynamic expansion of the cranial vault guided by brain growth.

Effects of rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats

Objective Distraction osteogenesis typically requires a long treatment period, which can lead to bone and soft-tissue infection and considerable patient discomfort. Use of a rapid distraction rate in craniofacial distraction osteogenesis to shorten the distraction period is possible owing to the unique characteristics of craniofacial bones, including an abundant blood supply and rapid bone healing compared with long bones. The effects of using a rapid distraction rate in the treatment of craniofacial deformities are currently unclear, however. The objective of this study was to investigate the effects of a rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats. Methods Sixteen goats were randomly divided into four groups consisting of four goats each. In Groups A, B, and C, the right mandible of each goat was distracted at a rate of 0.8 mm/d, 1.6 mm/d, and 2.0 mm/d, respectively; Group D was the control group and did not undergo distraction. Six weeks after the conclusion of distraction, bone densitometry and three-point bending testing were performed in all groups. Results The mean bone density value of goats in Group A was significantly higher than those of all the other groups ( p < 0.05), and the mean bone density value of goats in Group C was significantly lower than those of all the other groups ( p < 0.05). The mean curve slope, peak stress, bending modulus, and energy to failure values of Groups A, B, and C were all significantly lower than those of the control group ( p < 0.05). As the distraction rate increased, the curve slope and peak stress values gradually declined ( p < 0.05). Conclusions Use of a rapid distraction rate in mandibular distraction osteogenesis may have detrimental effects on the quality of new bone, despite the abundant blood supply of craniofacial bones.

Distraction Osteogenesis for the Craniomaxillofacial Region. Part 1: a Compendium of Devices for the Maxilla and Midface

Distraction osteogenesis is gaining in popularity as it can overcome the limitations of conventional surgery. Although the method was initially developed for limb lengthening, it is now applied extensively in the treatment of craniofacial deformities. This article reviews the currently available maxillary and midfacial distractors, and aims to provide oral and maxillofacial surgeons a good understanding of distraction osteogenesis related to the development of distractors and the factors influencing the choices for application in the craniofacial region.

Stereolithography for Craniofacial Surgery

Advances in computer technology have aided in the diagnostic and clinical management of complex congenital craniofacial deformities. The use of stereolithographic models has begun to replace traditional milled models in the treatment of craniofacial deformities. Research has shown that stereolithography models are highly accurate and provide added information in treatment planning for the correction of craniofacial deformities. These include the added visualization of the complex craniofacial anatomy and preoperative surgical planning with a highly accurate three-dimensional model. While the stereolithographic process has had a beneficial impact on the field of craniofacial surgery, the added cost of the procedure continues to be a hindrance to its widespread acceptance in clinical practice. With improved technology and accessibility the utilization of stereolithography in craniofacial surgery is expected to increase. This review will highlight the development and current usage of stereolithography in craniofacial surgery and provide illustration of it use.

Potential and Limitations of Cephalometric Analysis of Maxillofacial Bone Movement in the Case of LeFort III-Distraction

The treatment of craniofacial deformities by means of distraction osteogenesis has become an established therapeutic procedure. Evaluation of the success of an operation is usually carried out via conventional cephalometry. Conventional forms of analysis seem problematic due to surgically-induced changes in the skull base. In this study we investigated the movement of the midface in the presence of a syndromerelated surgical indication employing two different types of analysis, namely those of Ricketts and Delaire. It seems that neither procedure is suitable for determining this type of bone movement conclusively. Comparing the two, the Delaire analysis possessed greater informative value in view of the altered geometry, and a combination of both procedures made more exact determination possible of the final position achieved.

Dynamic spring-mediated cranioplasty in a rabbit model.

Since the beginning of craniofacial surgery, there has been an ongoing search for surgical techniques to enhance outcome while, at the same time, decreasing the invasiveness of the surgical treatment of craniofacial deformities. The purpose of this study was to test a recently reported minimally invasive treatment modality, the dynamic spring, in a rabbit calvarial model for efficacy and safety. Specifically, the results of spring cranioplasty on skull growth, the underlying brain, and adjacent bone were to be assessed. The study population consisted of 36 7-week-old New Zealand white rabbits. The rabbits were divided into four treatment groups (9 rabbits each): control, sham surgery, stainless steel springs, and memory metal springs. Postoperative analysis included weekly radiographs to evaluate movement of amalgam markers placed at standardized locations. Additionally, 16 rabbits (4 from each group) were killed at 14 days after surgery, and postmortem histological analysis was done. The remaining rabbits were followed until they were adults and were then killed and similarly analyzed. No morbidity or mortality occurred in the immediate perioperative period secondary to the surgery. Postmortem histological analysis of all study animals revealed no intracranial, subcutaneous, or skin infections and no technical complications related to the surgery. Statistical analysis using ANOVA and pair-wise comparisons between treatment groups revealed a statistically significant difference (P < 0.05) between the marker movement in the spring groups versus the sham and control groups. There were no significant differences between the sham and control groups or between the two spring groups. In conclusion, this study confirms the efficacy and safety of the dynamic spring in a rabbit model.

Midfacial advancement by bone distraction for treatment of craniofacial deformities.

Craniofaciostenosis is often associated with midfacial hypoplasia and has been treated traditionally using Le Fort advancement osteotomies and bone grafts. The surgical procedure requires a prolonged operating time, several osteotomies with a significant blood loss, and wide surgical exposure. According to the principles of bone lengthening, we performed midfacial advancement by bone distraction in 4 patients with midfacial hypoplasia to reduce the operative time and complication rate. In 2 patients with Crouzon's syndrome we performed a Le Fort III osteotomy and placed the distraction device behind the malar eminence and screwed it on the temporal bone bilaterally. In the other 2 children, with Apert's syndrome, we performed frontal advancement and remodeling before placing the device during the same surgery behind the malar bone without any midfacial osteotomy. It appears to us that patients with more severe deformities will need surgical procedures to offer more satisfactory results. In these patients, distraction is an initial therapy to reduce the severity of the deformity, making it possible to effect a better treatment afterward.

Distraction osteogenesis in craniofacial surgery: a review.

Distraction osteogenesis is a technique of new bone formation by the gradual separation of bony fragments. The method, although initially developed for limb lengthening, is now being applied in the treatment of craniofacial deformities. A number of principles have been established through careful scientific study to guide clinical practice, such as the ideal rate and rhythm of distraction, the need for periosteal preservation during bone division, a "latent period" of neutral fixation before, and a "consolidation period" after distraction. The technique is being applied in craniofacial surgery particularly for mandibular deformities and offers considerable advantages over previous methods such as osteotomy and inlay bone grafting. Donor site morbidity is avoided, the investing soft tissue envelope is concurrently expanded, and the magnitude of the procedure is less. However, the technique is still in its infancy and requires further modification and refinement before widespread acceptance as a treatment in mainstream craniofacial surgery. Problems with cutaneous scarring and socially undesirable external hardware, particularly in the pediatric population, have led to the emergence of intraoral miniature devices, with the ultimate goal of development of a multiplanar internal autodistractor. Furthermore, many principles well established in leg lengthening, such as the rate and rhythm of distraction, need to be reexamined and the parameters redefined with particular reference to the craniofacial skeleton. Distraction osteogenesis has an expanding role in craniofacial surgery.

Effects of Managed Care on the Treatment of Craniofacial Deformities

Effects of Managed Care on the Treatment of Craniofacial Deformities

Early treatment of craniofacial deformities

Early treatment of craniofacial deformities

Motion of Bone Segments after Surgical-Orthodontic Correction of Craniofacial Deformities

After surgical-orthodontic treatment of craniofacial deformities in six patients, motion of the segments was recorded with a high degree of accuracy. During fixation and a three year follow-up period small movements of the segments were observed while there were no visible changes in the dental occlusion. The observed motion was regarded mainly as an indication of a continuous adjustment of the jaws to a functional imbalance created by surgery.