- Email: [email protected]
Minor malformations in case of cleft lip, palate and craniofacial syndromes
Posters 143 injuries to the upper third of the face. After the initial healing of the words, approximately 6 months, we performed osteoplastic operations to replace bone tissue with monocortical iliac grafts. We obtained excellent results both aesthetically and functionally.
New Method of Computed Tomography Upper Airway Measurement and New Computed Tomography Positioning Technique in Patients with Sleep Apnoea
Longerich U.J., Sailer H.E Kiefer- und Gesichtschirurgie, Universitiitsspital Zfirich, Zfirich, Switzerland Under specific anatomical conditions, a collapse of the posterior upper airway (UA) of the laryngeal airway and extrathoracic trachea will be induced by repetitive narrowing during sleep in patients with obstructive sleep apnoea (OSA). It might be a threshold of a UA calibre correlated with a value of a negative inspiratory pressure, maybe an UA calibre/inspiratory pressure ratio (UAC/IP), which induces a point-of-no-return reaction with collapse of UA. In order to prove if this hypothetical UAC/IP ratio is correct, the first step is the detailed three-dimensional (3-D) evaluation of the anatomical environment of the UA space. There are a wide range of anatomical possibilities, which will narrow the airway calibre and increase the tendency of an UA collapse with decreasing of hypothetical UAC/IP ratio. Anatomical variation of the oropharyngeal and nasopharyngeal airway, such as anterior movement of the retropharyngeal soft tissues, inferior and posterior displacement of tonsils, narrowing of the airway between the palate and the adenoids, posterior movement of the mandible give an impression about the multifactorial aetiology of a phenomenon which occurs with the same feature: collapse of the UA. Therefore, a 3-D anatomical investigation of the UA should be individually correlated to the surrounding anatomical structures, which form the 3-D-UA space in the end. This study demonstrates new methods of 3-D-UA measurement to investigate individually the anatomical border structures of the UA and their influence in decreasing the UA space. Of special importance for the clinical evaluation is a new patient positioning technique: supine and prone positioning both in the axial exposure of radiation. On the basis of computed tomograph (CT) images with soft tissue window (Philipps CT), 3-D-reconstruction images in 10°-graduation in x,y,z-direction from UA and specific anatomical structures were produced by a Philipps Gyroview off-line workstation. The 10° graduated 3-Dimage datasets were exported to the Virtual Patient System® (Fa.Artma), where the 3-D reconstructed individual anatomical structure could be shown in relationship to the surface of the 3D reconstructed UA and skull. The measurement of the narrowing tendency of the individual anatomical structure to the 3-D-reconstructed UA space due to supine and prone patient positioning is supported by newly developed software.
Minor Malformations in Case of Cleft Lip, Palate and Craniofacial Syndromes
L6vi-Kalnin M., Jagomiigi T. Department of Oral and Maxillofacial Surgery, University of Tartu, Tartu, Estonia
This study analyzes congenital facial microanomalies as well as some signs on the extremities cleft lip and palate and maxillofacial syndrome. A mass screening for malformations was carried out in 2674 subjects (1331 males and 1343 females) of Estonia, of whom 344 had facial clefts, 686 were healthy relatives of the patients and 1644 were healthy subjects not related to the patients. Twenty-six features were observed empirically and 3 parameters of the maxillofacial region were examined anthropometrically. Symptomatic microanomalies seem to be asymmetry and flattening of the ala nasi, deviation of the septum nasi and cleft of the uvula, the mean incidence of which (30.6 + 1.7% and 4.3 + 0.5%, respectively) is 7 times higher among the patients' relatives than is in the normal population. The difference is statistically significant (P < 0.00005). The complex of the following features - euriopia, epicanthus and sometimes strabismus - can be regarded as a naso-ocular syndrome suggesting a hereditary aetiology of the disease. The relatives of the cleft patients had this syndrome more frequently than the control group, the incidence being 5.7 -+ 0.9% and 0.2 + 0.03%, respectively. The relatives of patients with Robin' syndrome, Goldenhar syndrome, Klein and Franceschetti syndrome, lip and palate clefts with lower diverticulars also demonstrated a higher incidence of microanomalies than the control group. The results of this study point to the genetic origin of facial clefts and syndromes and they can be helpful in medical consultations.
Central Odontogenic Fibroma: A Report of Three Cases Illustrating the Diagnostic Problems of this Tumour
Makos C., TriantafillidouK., Karnezi E. Aristotle University, Thessaloniki, Greece Central odontogenic fibroma is a rare benign tumour arising within the jaws. The relatively few reports in the literature suggest that odontogenic fibroma is rare and, in addition, its histogenesis and even its existence as an independent entity is disputed. Three female patients with an odontogenic fibroma, 4, 12 and 17-years-old, are described in this paper and used to illustrate differential diagnostic problems in this controversial group of lesions. Clinical manifestations and treatment are described. The histopathological differential diagnosis is discussed.
Post Traumatic Giant Mucocele of the Front-Orbitary Region
Marcelino J.P., Pereira1-1.,Amado L, FerreiraA., Ribeiro CA. Servifo Cirurgia Maxilo-Facial, Hospitais da Universidade de Coimbra, Coimbra, Portugal The authors present a clinical case of a post-traumatic giant mucocele of the front-orbitary region, in a patient who suffered craniofacial trauma about 20 years ago (which resulted in multiple fractures of the frontal orbitary region and loss of both ocular globes). In November 1995, he was admitted at the emergency room of our hospital due to a fall. He presented a giant bilateral frontal orbitary hematoma, but the family assures that it was previous to the accident. After clinical and radiological study we concluded that we were dealing with a giant mucocele of the frontal sinus with extension to both orbits. A cranialization of the frontal sinus with total exeresis of the lesion was performed without major complications. A few clinical and pathological considerations are made on this subject.
New Method of Computed Tomography Upper Airway Measurement and New Computed Tomography Positioning Technique in Patients with Sleep Apnoea
Longerich U.J., Sailer H.E Kiefer- und Gesichtschirurgie, Universitiitsspital Zfirich, Zfirich, Switzerland Under specific anatomical conditions, a collapse of the posterior upper airway (UA) of the laryngeal airway and extrathoracic trachea will be induced by repetitive narrowing during sleep in patients with obstructive sleep apnoea (OSA). It might be a threshold of a UA calibre correlated with a value of a negative inspiratory pressure, maybe an UA calibre/inspiratory pressure ratio (UAC/IP), which induces a point-of-no-return reaction with collapse of UA. In order to prove if this hypothetical UAC/IP ratio is correct, the first step is the detailed three-dimensional (3-D) evaluation of the anatomical environment of the UA space. There are a wide range of anatomical possibilities, which will narrow the airway calibre and increase the tendency of an UA collapse with decreasing of hypothetical UAC/IP ratio. Anatomical variation of the oropharyngeal and nasopharyngeal airway, such as anterior movement of the retropharyngeal soft tissues, inferior and posterior displacement of tonsils, narrowing of the airway between the palate and the adenoids, posterior movement of the mandible give an impression about the multifactorial aetiology of a phenomenon which occurs with the same feature: collapse of the UA. Therefore, a 3-D anatomical investigation of the UA should be individually correlated to the surrounding anatomical structures, which form the 3-D-UA space in the end. This study demonstrates new methods of 3-D-UA measurement to investigate individually the anatomical border structures of the UA and their influence in decreasing the UA space. Of special importance for the clinical evaluation is a new patient positioning technique: supine and prone positioning both in the axial exposure of radiation. On the basis of computed tomograph (CT) images with soft tissue window (Philipps CT), 3-D-reconstruction images in 10°-graduation in x,y,z-direction from UA and specific anatomical structures were produced by a Philipps Gyroview off-line workstation. The 10° graduated 3-Dimage datasets were exported to the Virtual Patient System® (Fa.Artma), where the 3-D reconstructed individual anatomical structure could be shown in relationship to the surface of the 3D reconstructed UA and skull. The measurement of the narrowing tendency of the individual anatomical structure to the 3-D-reconstructed UA space due to supine and prone patient positioning is supported by newly developed software.
Minor Malformations in Case of Cleft Lip, Palate and Craniofacial Syndromes
L6vi-Kalnin M., Jagomiigi T. Department of Oral and Maxillofacial Surgery, University of Tartu, Tartu, Estonia
This study analyzes congenital facial microanomalies as well as some signs on the extremities cleft lip and palate and maxillofacial syndrome. A mass screening for malformations was carried out in 2674 subjects (1331 males and 1343 females) of Estonia, of whom 344 had facial clefts, 686 were healthy relatives of the patients and 1644 were healthy subjects not related to the patients. Twenty-six features were observed empirically and 3 parameters of the maxillofacial region were examined anthropometrically. Symptomatic microanomalies seem to be asymmetry and flattening of the ala nasi, deviation of the septum nasi and cleft of the uvula, the mean incidence of which (30.6 + 1.7% and 4.3 + 0.5%, respectively) is 7 times higher among the patients' relatives than is in the normal population. The difference is statistically significant (P < 0.00005). The complex of the following features - euriopia, epicanthus and sometimes strabismus - can be regarded as a naso-ocular syndrome suggesting a hereditary aetiology of the disease. The relatives of the cleft patients had this syndrome more frequently than the control group, the incidence being 5.7 -+ 0.9% and 0.2 + 0.03%, respectively. The relatives of patients with Robin' syndrome, Goldenhar syndrome, Klein and Franceschetti syndrome, lip and palate clefts with lower diverticulars also demonstrated a higher incidence of microanomalies than the control group. The results of this study point to the genetic origin of facial clefts and syndromes and they can be helpful in medical consultations.
Central Odontogenic Fibroma: A Report of Three Cases Illustrating the Diagnostic Problems of this Tumour
Makos C., TriantafillidouK., Karnezi E. Aristotle University, Thessaloniki, Greece Central odontogenic fibroma is a rare benign tumour arising within the jaws. The relatively few reports in the literature suggest that odontogenic fibroma is rare and, in addition, its histogenesis and even its existence as an independent entity is disputed. Three female patients with an odontogenic fibroma, 4, 12 and 17-years-old, are described in this paper and used to illustrate differential diagnostic problems in this controversial group of lesions. Clinical manifestations and treatment are described. The histopathological differential diagnosis is discussed.
Post Traumatic Giant Mucocele of the Front-Orbitary Region
Marcelino J.P., Pereira1-1.,Amado L, FerreiraA., Ribeiro CA. Servifo Cirurgia Maxilo-Facial, Hospitais da Universidade de Coimbra, Coimbra, Portugal The authors present a clinical case of a post-traumatic giant mucocele of the front-orbitary region, in a patient who suffered craniofacial trauma about 20 years ago (which resulted in multiple fractures of the frontal orbitary region and loss of both ocular globes). In November 1995, he was admitted at the emergency room of our hospital due to a fall. He presented a giant bilateral frontal orbitary hematoma, but the family assures that it was previous to the accident. After clinical and radiological study we concluded that we were dealing with a giant mucocele of the frontal sinus with extension to both orbits. A cranialization of the frontal sinus with total exeresis of the lesion was performed without major complications. A few clinical and pathological considerations are made on this subject.