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O.083 The human face: a new perspective from evolutionary developmental biology (EVO-DEVO) and neuroscience
Oral Presentations
Ante-natal diagnostic, embryology and surgery of the cleft malformations III
After surgery the situation is completely different. Many procedures are available to every single surgeon to correct the malformation and all of them cause hundreds of different clinical presentations during childhood. The effects of scars on both soft and bony tissues can produce distortions or growth deficiency that necessitate surgical treatment. Surgical treatment of maxillary hypoplasia includes standard orthognatic procedures, such as one or two jaws surgery with or without genioplasty, and other procedures customized for special cases. Cranial bone grafts around the piriform aperture can camouflage a poor projection of the maxilla; Posnick modification of the standard Le Fort I level osteotomy can be useful in closing an oronasal fistula and alveolar bone defect and simultaneously correct the occlusion; distraction osteogenesis can be used to expand a contracted maxilla; distraction osteogenesis, with external or internal devices, can correct a severe retrusion of the maxilla; free fibula flap can be used to reconstruct a missing premaxilla. Authors will show some cases treated with standard orthognatic procedures along with special cases that required customized treatment. O.081 Secondary treatment of CLP patients: the soft tissues M. Zama, S. Latorre, G. Spuntarelli, L. Santecchia, F. Maggiulli. Ospedale Pediatrico Bambino Ges`u, Roma, Italy Clinical presentation of cleft lip and palate at birth is relatively uniform. This is not to say that all clefts are the same but that the variety is limited and that the malformation is relatively predictable. After surgery the situation is completely different. Many procedures are available to every single surgeon to correct the malformation and all of them cause hundreds of different clinical presentations during childhood. The effects of scars on both soft and bony tissues can produce distortions or growth deficiency that necessitate surgical treatment. Lip and nose revision is always necessary to erase all the signs of the malformation and surgical treatment have to be planned as early as possible to prevent negative effects on the facial skeleton. Abb´e flap is the procedure of choice to reconstruct the median portion of the upper lip in order to correct its horizontal deficiency and rebuild the filtrum. Rhinoplasty in cleft patients is always made through an open approach. In this manner a perfect exposure of the nasal skeleton is achieved and all distorted structures are identified. Resection of distorted cartilaginous septum is performed and the cartilage is used as strut graft in the columella. Millard technique is used to reposition the altered domus which is or are sutured to the septum and the columellar strut. Resection of the excess of alar cartilages is done and tip is grafted with a Sheen shield, if needed. Authors present some cases treated in the last years with the cited protocol. O.082 Taking charge of the bilateral orbito facial cleft from two cases F. Nderagakura1 , M. Obama2 , G. Moutemy3 , Ph. Naepels4 , M. Mathiieu5 , Chr. Tougne1,6 , S. Testelin1 , B. Devauchelle6 . 1 Service de Chirurgie Maxillofaciele et de Stomatologie, Soissons, France; 2 Service de P´ediatrie, CHU de Yaound´e, Cameroun, France; 3 Service de P´ediatrie, CH de Laon, France; 4 Service d’Echographie obst´etricale, Amiens, France; 5 D´ epartement de P´ediatrie et de G´en´etique clinique, Amiens, France; 6 Service de Chirurgir Maxillofaciale et de Stomatologie, Amiens, France The maxillofacial malformations raise problems of taking charge according to the severity of the anomaly. The obstetrical echography enable a prenatal diagnosis from the 22nd week, the evolution
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of the stage of malformation on Paul Tessier’s scale, (P. Tessier who worked out the classification of 4 clinic forms in 1977). Taking charge begins with the parents information before the baby’s birth and the answer to the questions they may ask. Some clinic forms of facial clefts exist rarely and are not compatible with human life. The exceptional aspect of the bilateral orbitofacial cleft (classified number 4 on P. Tessier’s scale), we are reporting explains the lack of codification in the treatement and the need to adapt the times of therapy with the child’s growth. Relying on an experience comparable to a nearly similar survey, but at distance of time we can mention the first results and foresee a clinic support of this child with serenity. O.083 The human face: a new perspective from evolutionary developmental biology (EVO-DEVO) and neuroscience G. Bernasconi. Universit`a di Pavia, Pavia, Italy The evolutional process of the human face has had to preserve the vitality of the original energy-metabolically building. For this reason, the conforming and performing developmental programs strongly contain the information to satisfy obligatory functions represented in the facial space. The last decades give a new perspective to understand these essential vital mechanisms. These new streams of research tell us that there are different ways to analyze and to preserve the relapse of orthognathic and TMJ patients. They also reveal some different therapeutic goals for cleft and craniofacial malformations. Biological and functional programs find into the morphology their visible justification; but in order to really understand the therapeutic needs, we have to recognize the “unicum vitae” procedure. The evolutional origin of the face explains what we have to preserve during our therapeutic protocols. Ventilation and chewingswalling spatial functional dimensions are the essential needs we have to maintain. The facial volume obtains its primary origine from the arising life because of the essential metabolically induced information; after oxygen bottleneck, the segmentation of the body of the ancient protist heterotrophic eucaryote has been the beginning of conforming and performing face volume; then the complex evolutionary history of neural crest, mesodermal original scope, branchial arches and conforming signals achieve the final explanation for the face planning program. Furthermore, mandibular and head-neck movements during foetal yawning and natural jaw function suggest the performance fitness for the human face. A summary of this new perspective will be proposed. O.084 The pharyngeal flap: analysis of post-op complications P. Cole, Y. Kaufman, V. Boyd, S. Stal. Baylor College of Medicine, Houston, USA Background: The most frequent surgical treatment of velopharyngeal insufficiency (VPI), the pharyngeal flap is also one of the more dangerous pediatric procedures due to the potential for airway obstruction and patient death. Prompted by recent concern of high complication rates associated with this procedure, we completed a retrospective cohort study to evaluate the incidence and character of post-operative complications following 222 consecutive pharyngeal flap surgeries. Methods: A database review was undertaken of all pharyngeal flap surgeries completed from January 2000 to April 2006 at a tertiary, pediatric craniofacial center. Main outcome measures included post-operative complications, such as airway compromise manifested as oxygen desaturation, hemorrhage requiring reoperation, wound infection, pharyngeal flap break down, and development of obstructive sleep apnea.
Ante-natal diagnostic, embryology and surgery of the cleft malformations III
After surgery the situation is completely different. Many procedures are available to every single surgeon to correct the malformation and all of them cause hundreds of different clinical presentations during childhood. The effects of scars on both soft and bony tissues can produce distortions or growth deficiency that necessitate surgical treatment. Surgical treatment of maxillary hypoplasia includes standard orthognatic procedures, such as one or two jaws surgery with or without genioplasty, and other procedures customized for special cases. Cranial bone grafts around the piriform aperture can camouflage a poor projection of the maxilla; Posnick modification of the standard Le Fort I level osteotomy can be useful in closing an oronasal fistula and alveolar bone defect and simultaneously correct the occlusion; distraction osteogenesis can be used to expand a contracted maxilla; distraction osteogenesis, with external or internal devices, can correct a severe retrusion of the maxilla; free fibula flap can be used to reconstruct a missing premaxilla. Authors will show some cases treated with standard orthognatic procedures along with special cases that required customized treatment. O.081 Secondary treatment of CLP patients: the soft tissues M. Zama, S. Latorre, G. Spuntarelli, L. Santecchia, F. Maggiulli. Ospedale Pediatrico Bambino Ges`u, Roma, Italy Clinical presentation of cleft lip and palate at birth is relatively uniform. This is not to say that all clefts are the same but that the variety is limited and that the malformation is relatively predictable. After surgery the situation is completely different. Many procedures are available to every single surgeon to correct the malformation and all of them cause hundreds of different clinical presentations during childhood. The effects of scars on both soft and bony tissues can produce distortions or growth deficiency that necessitate surgical treatment. Lip and nose revision is always necessary to erase all the signs of the malformation and surgical treatment have to be planned as early as possible to prevent negative effects on the facial skeleton. Abb´e flap is the procedure of choice to reconstruct the median portion of the upper lip in order to correct its horizontal deficiency and rebuild the filtrum. Rhinoplasty in cleft patients is always made through an open approach. In this manner a perfect exposure of the nasal skeleton is achieved and all distorted structures are identified. Resection of distorted cartilaginous septum is performed and the cartilage is used as strut graft in the columella. Millard technique is used to reposition the altered domus which is or are sutured to the septum and the columellar strut. Resection of the excess of alar cartilages is done and tip is grafted with a Sheen shield, if needed. Authors present some cases treated in the last years with the cited protocol. O.082 Taking charge of the bilateral orbito facial cleft from two cases F. Nderagakura1 , M. Obama2 , G. Moutemy3 , Ph. Naepels4 , M. Mathiieu5 , Chr. Tougne1,6 , S. Testelin1 , B. Devauchelle6 . 1 Service de Chirurgie Maxillofaciele et de Stomatologie, Soissons, France; 2 Service de P´ediatrie, CHU de Yaound´e, Cameroun, France; 3 Service de P´ediatrie, CH de Laon, France; 4 Service d’Echographie obst´etricale, Amiens, France; 5 D´ epartement de P´ediatrie et de G´en´etique clinique, Amiens, France; 6 Service de Chirurgir Maxillofaciale et de Stomatologie, Amiens, France The maxillofacial malformations raise problems of taking charge according to the severity of the anomaly. The obstetrical echography enable a prenatal diagnosis from the 22nd week, the evolution
S21
of the stage of malformation on Paul Tessier’s scale, (P. Tessier who worked out the classification of 4 clinic forms in 1977). Taking charge begins with the parents information before the baby’s birth and the answer to the questions they may ask. Some clinic forms of facial clefts exist rarely and are not compatible with human life. The exceptional aspect of the bilateral orbitofacial cleft (classified number 4 on P. Tessier’s scale), we are reporting explains the lack of codification in the treatement and the need to adapt the times of therapy with the child’s growth. Relying on an experience comparable to a nearly similar survey, but at distance of time we can mention the first results and foresee a clinic support of this child with serenity. O.083 The human face: a new perspective from evolutionary developmental biology (EVO-DEVO) and neuroscience G. Bernasconi. Universit`a di Pavia, Pavia, Italy The evolutional process of the human face has had to preserve the vitality of the original energy-metabolically building. For this reason, the conforming and performing developmental programs strongly contain the information to satisfy obligatory functions represented in the facial space. The last decades give a new perspective to understand these essential vital mechanisms. These new streams of research tell us that there are different ways to analyze and to preserve the relapse of orthognathic and TMJ patients. They also reveal some different therapeutic goals for cleft and craniofacial malformations. Biological and functional programs find into the morphology their visible justification; but in order to really understand the therapeutic needs, we have to recognize the “unicum vitae” procedure. The evolutional origin of the face explains what we have to preserve during our therapeutic protocols. Ventilation and chewingswalling spatial functional dimensions are the essential needs we have to maintain. The facial volume obtains its primary origine from the arising life because of the essential metabolically induced information; after oxygen bottleneck, the segmentation of the body of the ancient protist heterotrophic eucaryote has been the beginning of conforming and performing face volume; then the complex evolutionary history of neural crest, mesodermal original scope, branchial arches and conforming signals achieve the final explanation for the face planning program. Furthermore, mandibular and head-neck movements during foetal yawning and natural jaw function suggest the performance fitness for the human face. A summary of this new perspective will be proposed. O.084 The pharyngeal flap: analysis of post-op complications P. Cole, Y. Kaufman, V. Boyd, S. Stal. Baylor College of Medicine, Houston, USA Background: The most frequent surgical treatment of velopharyngeal insufficiency (VPI), the pharyngeal flap is also one of the more dangerous pediatric procedures due to the potential for airway obstruction and patient death. Prompted by recent concern of high complication rates associated with this procedure, we completed a retrospective cohort study to evaluate the incidence and character of post-operative complications following 222 consecutive pharyngeal flap surgeries. Methods: A database review was undertaken of all pharyngeal flap surgeries completed from January 2000 to April 2006 at a tertiary, pediatric craniofacial center. Main outcome measures included post-operative complications, such as airway compromise manifested as oxygen desaturation, hemorrhage requiring reoperation, wound infection, pharyngeal flap break down, and development of obstructive sleep apnea.