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Paradoxical Mandibular Growth Pattern in Craniofacial Microsomia Patients
Poster Session retrospective study which reviewed 247 consecutive palatal operations (double opposing furlow z-plasty) by a single surgeon at a single institution, noting the incidence of airway problems before during and after the operations was 5.7 % Our study showed two cases which were not associated with syndromes whereas 93% were associated with syndromes in previous study. PRS was not found to have as many incidences as other articles. Etiologies to this complication have only been hypothesized due to the limited number of cases reported and variability within studies. References: 1. J Oral Maxillofac Surg. 2009 Jun;67(6):1326-8. http://dx.doi.org/ 10.1016/j.joms.2008.12.046. 2. Severe glossal edema after primary palatoplasty. Aziz SR, Ziccardi VB. Cleft Palate Craniofac J. 2002 Mar;39(2):145-8. 3. Airway obstruction following palatoplasty: analysis of 247 consecutive operations. Antony AK, Sloan GM. J Anaesthesiol Clin Pharmacol. 2013 Apr;29(2):262-3. http://dx.doi.org/10.4103/0970-9185.111670. 4. Massive lingual swelling following cleft palate repair. Rajesh M, Kuriakose S, Sukumar J, Ramdas E.
ramal height deficiecy. Mean length of follow up was 4 years. The 3dct measurements were assesed, means and standard deviations were calculated for each group, a two-tailed student’s t-test was performed, with *p <0.05 considered significant. All data was assessed by three blinded independent observers. The panoramic radiographs showed that in the affected side, the mandibular body was longer than the unaffected side mandible body in patients with paradoxical growth. This difference in body length was not observed in the control group. Further there was no gap between the glenoid fossa and top of the affected ramus. The glenoid fossa tended to be in a lower vertical position on the affected side in patients with the paradoxical growth pattern. Patients with paradoxical growth showed lengthening of the mandibular body on the affected side rather than the unaffected side and the glenoid fossa was lower on the affected side. This unusual pattern of growth could compensate for a congenitally short ramus and keep the occlusal plane level. Patients with this type of paradoxical growth pattern express a less severe phenotype of hemifacial microsomia.
POSTER 12 Paradoxical Mandibular Growth Pattern in Craniofacial Microsomia Patients M. Scott: Children’s Hospital Los Angeles, S. Yen Mandibular growth in craniofacial microsomia characteristically favors the affected side. However, we have observed the opposite growth pattern in a minority of patients. Here, we describe four patients with facial features of hemifacial microsomia which showed a paradoxical growth pattern (occlusal plane remained level and the mandible did not shift to the side with the short ramus). The purpose of this study was to analyze unusual mandibular growth patterns in subjects with hemifacial microsomia using measurements from panoramic radiographs and cone beam computed tomography (CBCT) scans. We will test the hypothesis that changes in mandibular body length compensated for the differences in ramal height. Four subjects treated at Childrens Hospital Los Angeles (3 male and 1 female) age ranging from 4 to 17 years were found to have this paradoxical growth pattern. The subjects underwent a three dimensional analysis using NewTom 9000 CBST scans for: Ramal length (Co-Go) and body length (Go-Mid-symphysis) were measured on the affected and unaffected sides and mandibular length (Co-Mid-symphysis). These measurements were compared to control groups of hemifacial microsomia patients with similar ramal height deficiency, but who lacked the paradoxical growth pattern. Sample size consists of four patient with paradoxical hemifacial microsomia and four age matched controls with conventional hemifacial microsomia and similar e-58
References: 1. Horgan JE, Padwa BL, LabrieRA, Mulliken JA, OMENS-Plus: Analysis of Craniofacial and Extracraniofacial Anomalies in Hemifacial Microsomia. Cleft Palate Craniofac J 1995 32(5):405-412 2. Birgfeld CB, Luquetti DV, Gougoutas AJ, Barlett SP, Low DW, Sie KC, Evans KN, Heike. A Phenotypic assessment tool for craniofa cial microsomia, Plastic Reconstr Surg. 2011 Jan;127(1):313-20.
POSTER 13 Clinical study on mandibular fracture after marginal resection of the mandible K. Okuyama: Tokyo Medical and Dental University, Y. Michi, M. Yamashiro, K. Harada Marginal resection (MR) of the mandible results in better esthetic and functional outcomes after surgery than segmental resection. On the other hand, MR has risks of mandibular fracture (MF) after surgery due to the decrease of mandibular strength depending on the reduction of the mandibular body height (MBH). It is reported that the MBH should be at least more than 10 mm to prevent the MF1. In this study, we examined the various factors of postoperative MF retrospectively including the postoperative MBH not by measuring its actual height but by calculating the preserving rates of postoperative MBH. The subjects were 47 patients who underwent MR from 2003 to 2012 in our department. We assessed the age, sex, resection area, occlusion, number of tooth, use of denture, and irradiation in these patients. The postoperative occlusion was classified by Eichner’s method which indicates the stability of occlusion. In additon, we calculated the preserving rate of MBH and the rate AAOMS 2014
ramal height deficiecy. Mean length of follow up was 4 years. The 3dct measurements were assesed, means and standard deviations were calculated for each group, a two-tailed student’s t-test was performed, with *p <0.05 considered significant. All data was assessed by three blinded independent observers. The panoramic radiographs showed that in the affected side, the mandibular body was longer than the unaffected side mandible body in patients with paradoxical growth. This difference in body length was not observed in the control group. Further there was no gap between the glenoid fossa and top of the affected ramus. The glenoid fossa tended to be in a lower vertical position on the affected side in patients with the paradoxical growth pattern. Patients with paradoxical growth showed lengthening of the mandibular body on the affected side rather than the unaffected side and the glenoid fossa was lower on the affected side. This unusual pattern of growth could compensate for a congenitally short ramus and keep the occlusal plane level. Patients with this type of paradoxical growth pattern express a less severe phenotype of hemifacial microsomia.
POSTER 12 Paradoxical Mandibular Growth Pattern in Craniofacial Microsomia Patients M. Scott: Children’s Hospital Los Angeles, S. Yen Mandibular growth in craniofacial microsomia characteristically favors the affected side. However, we have observed the opposite growth pattern in a minority of patients. Here, we describe four patients with facial features of hemifacial microsomia which showed a paradoxical growth pattern (occlusal plane remained level and the mandible did not shift to the side with the short ramus). The purpose of this study was to analyze unusual mandibular growth patterns in subjects with hemifacial microsomia using measurements from panoramic radiographs and cone beam computed tomography (CBCT) scans. We will test the hypothesis that changes in mandibular body length compensated for the differences in ramal height. Four subjects treated at Childrens Hospital Los Angeles (3 male and 1 female) age ranging from 4 to 17 years were found to have this paradoxical growth pattern. The subjects underwent a three dimensional analysis using NewTom 9000 CBST scans for: Ramal length (Co-Go) and body length (Go-Mid-symphysis) were measured on the affected and unaffected sides and mandibular length (Co-Mid-symphysis). These measurements were compared to control groups of hemifacial microsomia patients with similar ramal height deficiency, but who lacked the paradoxical growth pattern. Sample size consists of four patient with paradoxical hemifacial microsomia and four age matched controls with conventional hemifacial microsomia and similar e-58
References: 1. Horgan JE, Padwa BL, LabrieRA, Mulliken JA, OMENS-Plus: Analysis of Craniofacial and Extracraniofacial Anomalies in Hemifacial Microsomia. Cleft Palate Craniofac J 1995 32(5):405-412 2. Birgfeld CB, Luquetti DV, Gougoutas AJ, Barlett SP, Low DW, Sie KC, Evans KN, Heike. A Phenotypic assessment tool for craniofa cial microsomia, Plastic Reconstr Surg. 2011 Jan;127(1):313-20.
POSTER 13 Clinical study on mandibular fracture after marginal resection of the mandible K. Okuyama: Tokyo Medical and Dental University, Y. Michi, M. Yamashiro, K. Harada Marginal resection (MR) of the mandible results in better esthetic and functional outcomes after surgery than segmental resection. On the other hand, MR has risks of mandibular fracture (MF) after surgery due to the decrease of mandibular strength depending on the reduction of the mandibular body height (MBH). It is reported that the MBH should be at least more than 10 mm to prevent the MF1. In this study, we examined the various factors of postoperative MF retrospectively including the postoperative MBH not by measuring its actual height but by calculating the preserving rates of postoperative MBH. The subjects were 47 patients who underwent MR from 2003 to 2012 in our department. We assessed the age, sex, resection area, occlusion, number of tooth, use of denture, and irradiation in these patients. The postoperative occlusion was classified by Eichner’s method which indicates the stability of occlusion. In additon, we calculated the preserving rate of MBH and the rate AAOMS 2014