Cerebral hemiatrophy (Dyke-Davidoff-Masson syndrome) in childhood: clinicoradiological analysis of 19 cases

BACKGROUND

The purpose of this study was to emphasize the clinical and imaging findings of 19 child cases of cerebral hemiatrophy.

METHODS

A total of 11 male and eight female patients underwent assessment with computed tomography and magnetic resonance imaging. The patients ranged from 1 to 17 years in age. The evaluated parameters were: location of the lesions, midline structural shift effect, ipsilateral calvarial and parenchymal changes.

RESULTS

Left cerebral hemiatrophy was seen in 14 of the cases while right cerebral hemiatrophy was observed in five cases. Unilateral calvarial thickening was seen in 11 cases, hyperpneumatization of paranasal sinuses in five, and hypoplasia of the middle frontal cranial fossa in three patients. Cerebral peduncle atrophy was noted in seven cases. In total, 11 patients had thalamic atrophy and lentiform nucleus hypoplasia. In one case, cerebral hemiatrophy was associated with ipsilateral large schizencephalic cleft and absence of the septum pellucidum, whereas in another case, there was diffuse cerebellar atrophy associated with cerebral hemiatrophy.

CONCLUSION

Computed tomography and, in particular, magnetic resonance imaging are the procedures of choice with respect to assessment of the etiology and extent of cerebral parenchymal involvement in cerebral hemiatrophy.

Soft tissue facial volumes and shape in skeletal Class III patients before and after orthognathic surgery treatment

BACKGROUND

To obtain the best surgical results in orthognathic surgery, treatment planning and the evaluation of results should be performed on measurable three-dimensional reproductions of the face of the patients, and compared to reference subjects.

METHODS

Seven women aged 18-35 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.7 months) surgical intervention (mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement). The three-dimensional coordinates of 50 soft tissue facial landmarks (face, eyes, nose, mouth and lips, ears) were collected with a noninvasive, electromagnetic digitizer; facial volumes were estimated, and compared to reference values collected in 87 healthy women of the same age and ethnic group. Inter-individual modifications in facial shape were also assessed.

RESULTS

Before surgery the patients had smaller faces than the reference women, with larger lower lips and noses. A large within-group variability was found. Surgical treatment significantly reduced total facial volume and mandibular volume, increased total and upper lip volumes (Student's t test, p<0.05), and made all values more homogenous within the group. Shape differences were significantly larger before than after surgery. On average, right side gonion was the landmark that moved the most, closely followed by menton, while the tragi and ala nasi moved the least. The three-dimensional approach used in this study enabled quantitative evaluation of the final soft tissue results of surgery, without submitting the patients to invasive procedures.

Occulocerebrocutaneous syndrome: a case report

Occulocerebrocutaneous syndrome is a rare condition characterized by orbital cysts and skin tags. The presence of supernumerary teeth has not previously been associated with this syndrome. A primary supernumerary tooth with a permanent supernumerary successor was found in this case. This highlights the importance of very careful examination when assessing children with syndromes.

Class II subdivision malocclusion types and evaluation of their asymmetries

INTRODUCTION

The primary objective of this study was to determine, by means of frontal photographic evaluation, the distribution of the 2 main types of Class II subdivision malocclusions. The secondary objective was to compare the dentoskeletal asymmetries in these 2 types with a group of normal-occlusion subjects by using submentovertex and posteroanterior radiographs.

METHODS

The experimental group included 44 untreated Class II subdivision malocclusion subjects with a mean age of 15.3 years. The control group included 30 subjects with normal occlusions with a mean age of 22.4 years. All had full complements of permanent teeth up to the first molars and had not received orthodontic treatment. Type 1 Class II subdivision malocclusion is coincidence of the maxillary dental midline with the facial midline and deviation of the mandibular midline. Type 2 has the opposite characteristics. The frontal photographs were evaluated subjectively by 2 examiners. In the submentovertex and posteroanterior radiographs, symmetry was assessed by measuring the relative difference in the spatial positions of dentoskeletal landmarks between the right and left sides. Independent t tests were used to compare the dentoskeletal asymmetries of types 1 and 2 with the normal-occlusion group.

RESULTS AND CONCLUSIONS

The results showed that 61.36% had type 1, 18.18% had type 2 Class II subdivision malocclusion, and 20.45% had mixed characteristics. The predominant asymmetric dentoalveolar characteristics of both types of Class II subdivision malocclusions were evident when individually compared with a normal-occlusion control group. There was a tendency for the type 1 subjects to have greater mandibular asymmetry than type 2, as compared with the control group.

Shprintzen (velo-cardio-facial) syndrome: a rare case

Shprintzen syndrome (velo-cardio-facial, VCFS) is a very rare morbid entity, seen in either familial or sporadic forms, with major clinical findings such as facial dysmorphism, cleft palate, cardiovascular (especially conotruncal-anomalies), mild/moderate mental retardation, or, more commonly, observed learning difficulty. Tendency to behavioral disorders and bipolar schizophrenic diseases may be present in these cases. Autosomal dominant inheritance has been reported. VCFS appears as a consequence of microdeletion in the 22q11 chromosomal band. Although each syndrome has different clinical reflections, genetically the defect is located on the same chromosome.A 4-year-old boy was admitted to our clinic with a syndromic face and the diagnosis of tetralogy of Fallot. The patient underwent total correction of the cardiac defect. Atypical facial appearance, cleft palate, and malformed hand-fingers were present. With the aid of pediatric and genetic consultation (fluorescence in situ hybridization test), Shprintzen syndrome was confirmed. Both early and late postoperative periods of the patient were uneventful. The patient was closely consulted by a specialist psychologist during and after the hospitalization period. These children can be integrated into social life earlier through early surgical intervention for cardiac defects and facial deformations as well as neurologic and/or neuropsychiatric evaluation.

Partial facial hemihyperplasia with 9 years of evolution: case report and review of the literature

Partial facial hemihyperplasia is a rare maxillofacial dysmorphosis of debatable etiology, and is frequently associated with relatively serious appearance and functional disorders depending on the degree of hyperplasia. We report here a case of partial facial hemihyperplasia with 9 years of evolution, describing the alterations observed during the follow-up period and discussing the main aspects of this poorly known entity.

3D-CT evaluation of facial asymmetry in patients with maxillofacial deformities

OBJECTIVE

The aims of this study were to characterize the symmetrical features of patients with facial deformities and to suggest a classification system for facial asymmetry based on 3-dimensional-computed tomography (3D-CT) evaluation.

STUDY DESIGN

Preoperative CT images were investigated for 49 patients with maxillofacial deformities. Asymmetry indices were calculated for some landmarks in the maxilla, mandibular body and the mandibular ramus regions.

RESULTS

Asymmetry was observed most frequently in the mandibular body region. The subjects were divided into 3 groups. Subjects without any asymmetry in the 3 regions were classified as Group I (44.9%). Groups II or III were defined for subjects without or with maxillary region asymmetry, respectively, and they were subcategorized. In Group IIA (8.2%), asymmetry was shown solely in the mandibular body region, and in Group IIB (18.4%), additional asymmetry was shown in the mandibular ramus region. Group IIIA (6.1%) showed asymmetry only in the maxillary region, and Group IIIB (22.4%) showed asymmetry in all 3 regions.

CONCLUSION

The 3D-CT classification for facial asymmetry has the potential to replace the conventional cephalometric classification.

The 3-Dimensional Construction of the Average 11-Year-Old Child Face: A Clinical Evaluation and Application

PURPOSE

This article describes construction of the average face and its application in the clinical environment.

SUBJECTS AND METHODS

A total of 72 children, mean age 11.8 years, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with 2 Minolta Vivid 900 (Minolta, Osaka, Japan) optical laser-scanning devices assembled as a stereo pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 seconds. These scanned images were processed and merged to form a composite 3-dimensional soft tissue reproduction of the subjects using commercially-available reverse modeling software. The differences in facial morphology were measured using shell deviation color maps. The average face was used to compare differences between male and female groups and 3 subjects with craniofacial anomalies.

RESULTS

The difference between the average male and female face was 0.460 +/- 0.353 mm. The areas of greatest deviation were at the zygomatic area and lower jaw line, with the males being more prominent. The results of the surface deviation between the subjects with craniofacial anomalies were significant.

CONCLUSIONS

The construction of the average face provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of craniofacial anomalies.

Isolated hemifacial hypertrophy: a case with upper airway obstruction and sensorineural hearing loss

Hemifacial hypertrophy is an uncommon developmental disorder characterized by facial asymmetry that involves abnormal bone development and facial enlargement. Many cases of hemihypertrophy have been reported since the first case was reported by Wagner in 1839. We identified a child diagnosed with hemifacial hypertrophy and sensorineural hearing loss who presented with upper airway obstruction and cyanosis. We discuss treatment selection and review the associated head and neck symptoms.

Study of dimensional alterations of the orbit following loss of the eye

PURPOSE

This study aimed to assess the dimensional alterations in the anterior region of the orbit after enucleation or evisceration.

MATERIALS AND METHODS

Analysis of orbital areas and perimeters of 17 patients with unilateral removal of the ocular bulb was performed, and posteroanterior radiographic examination was carried out by a single specialist, who had been previously calibrated.

RESULTS

Data obtained from measurements confirmed the clinically observed facial asymmetry.

CONCLUSION

The observation of asymmetry in the anterior orbital area, confirmed by our results, indicates early treatment to prevent orbital disturbances and will aid in the planning of prosthetic rehabilitation.

Unilateral mandibular widening with distraction osteogenesis

Mandibular widening with distraction osteogenesis (DO) has been shown to be an acceptable and stable treatment modality. Mandibular widening with DO is useful in relieving crowding and for restoring a rotated mandibular arch segment to its original condition. This is especially true when a patient has a unilateral medial displacement of the proximal segment of the mandible or a unilateral Brodie bite. This case report shows the application of mandibular widening with DO for skeletal reconstruction and prosthodontic preparation in a patient with unilateral medial displacement of the proximal segment of the mandible. The design of the osteotomy line and the placement of the distractor must be taken into consideration in a detailed procedure for unilateral mandibular widening of the mandible.

A family with features overlapping Okihiro syndrome, hemifacial microsomia and isolated Duane anomaly caused by a novelSALL4 mutation

The SALL4 gene encodes a putative zinc finger transcription factor and is located on chromosome 20q13.13-13.2. Mutations in SALL4 have been identified in patients with Okihiro syndrome, which is characterized by radial ray anomalies associated with a Duane anomaly. Here, we report an unusual family in which affected persons show an extremely variable phenotype consistent with either Okihiro syndrome, hemifacial microsomia, or isolated Duane anomaly. A novel nonsense mutation in the SALL4 gene was detected in all affected family members and obligate carriers. This mutation is located in exon 3, only 29 bp 5' of the most 3' intron, and would therefore be expected to escape the nonsense mediated mRNA decay pathway, which might explain the phenotypic variability and mild degree of limb involvement.

A computerized photographic assessment of the relationship between skeletal discrepancy and mandibular outline asymmetry

The aim of this study was to investigate the relationship between mandibular outline asymmetry and skeletal discrepancy in a sample of orthodontic patients (33 females, 33 males) aged from 8 to 19 years. Skeletal discrepancy was assessed in both the anteroposterior and vertical planes, using standard cephalometric analyses. All were photographed under standardized conditions and the photographs were then digitized for analysis using a computerized system to assess differences in four variables (area, perimeter, compactness and moment-ratio) between the right and left sides of the mandibular outline. The results showed good repeatability of the photographic, cephalometric and digitization methods. A statistically significant relationship was found between mandibular outline asymmetry and both anteroposterior and vertical skeletal discrepancy in this sample, when compared with patients with an average skeletal pattern. There appeared to be a statistically significant relationship between a reduced ANB angle (< 3 degrees) and mandibular outline asymmetry (P = 0.051), as well as between an increase in lower face height and mandibular asymmetry (P = 0.023).

Facial asymmetry with colon atresia

This case report describes an unusual combination of birth defects in a black South African child presenting with colon atresia, facial symmetry due to facial microsomia and brain abnormalities. The suspected aetiology is thought to be vascular disruption in the late embryonic period.

[Radiological and anthropometric analysis of the symmetry and direction of evolution of skulls from some historic populations]

INTRODUCTION

Asymmetry is a common phenomenon in nature. It is typical for the human body and for the skull as its part. Knowledge of asymmetry and normal anatomy, especially of variability which does not represent pathology but distinguishes individuals is the basis for correct interpretation of radiological findings concerning the skull both in research and diagnostic examinations widely performed in surgery, neurology, neurosurgery, internal medicine, or pediatrics. Analysis of fluctuating asymmetry reveals the influence of stress factors on human development and the ability of the organism to defend itself against stress. The aim of this work was to analyse the asymmetry of skulls from some historic populations and to describe changes in their anatomy over the ages.

MATERIAL AND METHODS

The material consisted of three skull groups: one contemporary with 82 skulls and two mediaeval (52 skulls from Cedynia and 77 skulls from Gródek on Bug). Direct measurements were done and the skull was X-rayed in the Posterior-Anterior and skull-base projections. Images were scanned and calibrated with MicroStation 95 Academic Edition software. Helmert's transformation with first-order polynomial was done to attain a suitable geometry. Vectorisation of axes and areas was performed on reference material. Using tools for measurement of vector elements, the distance between bilateral points of both sides of the skull were obtained. Data were analysed statistically.

RESULTS

The results of measurements were used to study the directional and fluctuating asymmetry. It was found that asymmetry of the skull was present in both historic populations. The following conclusions were drawn: changes in the distribution of directional and fluctuating asymmetry for individual dimensions have taken place over the ages. A high level of directional asymmetry in the facial part and fluctuating asymmetry in the calvaria is typical for contemporary skulls. The reverse is true for relations in the case of mediaeval skulls. A greater level of fluctuating asymmetry in contemporary skulls reveals greater influence of the developmental stress on the contemporary population and its weaker ability for compensation.

Goldenhar's syndrome associated with multiple congenital abnormalities

Goldenhar's syndrome is characterized by a combination of dermal epibulbar cysts, auricular appendices, malformation of ears, and vertebral anomalies. The average incidence ratio of Goldenhar's syndrome is estimated to be 1/5600, and the frequency of cardiovascular malformations of this syndrome is 5-58 per cent. Although the etiology of this disease is not fully understood, autosomal recessive or dominant inheritance is possible. The disease occurs as sporadic cases. Male:female ratio for the Goldenhar's syndrome is 2:1. A 72-day-old Goldenhar's syndrome case is reported who presented with multiple congenital anomalies.

Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features

Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.

The Determinants of Successful Distraction Osteogenesis of the Mandible in Hemifacial Microsomia From Longitudinal Results

The purpose of this study was to investigate sagittal, vertical, asymmetric skeletal characteristics that could determine successful distraction osteogenesis (DO) of the mandible in patients with hemifacial microsomia using longitudinal follow-up data. Lateral and posteroanterior cephalometric radiographs before DO (T0), after DO (T1), and after retention (T2) were analyzed to investigate initial skeletal characteristics, DO effect, and retention. From the measurements at T2, patients were classified into group 1 (good retention results, N = 10) and group 2 (poor results, N = 9). Sagittal, vertical, dental, and asymmetric variables were measured. The differences at each stage and during T0-T1 and T1-T2 between two groups were compared by Mann-Whitney u test, Wilcoxon signed rank test and ANOVA test. Pruzansky type significantly influenced the success or failure of DO. At T0, group 2 showed more retrognathic mandible, smaller ramus height, larger gonial angle, more inward ramus inclination of the affected side, and more chin point deviation to the affected side than did group 1. The major effects of DO on group 1 were lengthening of the ramus height, forward positioning of the mandible, increase of gonial angle, counterclockwise rotation caused by a decrease of the articular angle, increase of ramus inclination of the affected side, and improvement of occlusal canting and chin point deviation. However, by DO, group 2 showed clockwise rotation of the mandible, and less increase of the ramus height than did group 1. After retention, group 2 showed counterclockwise rotation of the mandible and little growth of the ramus height. Group 1 showed reverse tendency. These factors could contribute to the difference in long-term results between two groups.

An unusual bilateral oblique facial cleft in a newborn

An extremely rare case of asymmetrical bilateral oblique facial cleft presumably secondary to amniotic bands is presented. The cleft on the right side of the patient commenced from the lower lip through the maxillary region of the face to the temporal area and was described as a lower oro-temporal cleft to differentiate it from the previously reported type commencing from the upper lip.

Strategies for a successful corrective Asian blepharoplasty after previously failed revisions

Asian blepharoplasty, although a common procedure, has a relatively high rate of complications. Subtle imperfections and more serious iatrogenic complications often require immediate attention by the aesthetic surgeon. After attempted correction of the deformities, residual problems or new ones can arise. Blepharoptosis, supratarsal depression, an excessively high or low crease, a short or discontinuous crease, multiple creases, and asymmetric creases are the most commonly encountered complications that require special attention in this group, which has already undergone more than one surgical procedure. Between January of 1996 and December of 2002, 168 Asian blepharoplasty revisions were performed by one surgeon (S. H.-T. Chen); of these, 36 patients (21 percent) had previously undergone failed revisions. This subgroup of patients consisted of six with blepharoptosis, six with asymmetrical eyelid creases, three with supratarsal depressions, three with high creases, two with short creases, and 16 with combinations of these deformities. The results were graded as excellent, good, fair, or poor, based on the symmetry of the eyelids, palpebral fissures, crease heights, lengths, shapes, eyelid fullness, and overall aesthetics of the final outcome. A survey was performed of patient and surgeon satisfaction and factored into the grading system. With an average follow-up period of 16 months (6 to 60 months), 22 patients (61 percent) were found to have excellent results, 10 (28 percent) had good results, two (5.6 percent) had fair results, and two (5.6 percent) had poor results. Corrective procedures after failed revision Asian blepharoplasty require special strategic considerations because of the presence of extensive scarring and inadequate skin, muscle, and preaponeurotic fat and because of the occasional presence of dehiscence of the levator aponeurosis. By using careful preoperative evaluation, accurate measurements, precise preoperative planning, intraoperative fat repositioning or grafting, skin excision or redraping, and proper placement of anchoring sutures, successful outcomes can be achieved. The authors evaluate the outcomes and detail the surgical procedures that were used to achieve successful outcomes in this particularly challenging group of patients.

Unilateral Mandibular Ramus Elongation by Intraoral Distraction Osteogenesis

Successful correction of facial asymmetry by mandibular distraction osteogenesis relies on mastering vector control. Lack of necessary vector control continues to compromise the treatment modality. The purpose of this study was to describe a new simplified method for vector transfer and to evaluate this method according to the outcome and the efficacy of distraction osteogenesis in the correction of unilateral mandibular hypoplasia and asymmetry. Twenty-seven patients with unilateral hypoplasia of the mandibular ramus underwent unilateral mandibular distraction osteogenesis with intraoral distraction devices. Posterior-anterior and lateral cephalograms were analyzed by digitalization. Changes in sagittal, vertical, and transversal linear and angular dimensions after the distraction treatment were evaluated by measurements performed on headfilms taken before and after surgery. Means and variances were calculated for selected cephalometric variables for each time point. The differences between the control and the treatment side were calculated, statistically described, and compared with a paired Student t test. Correction of the mandibular asymmetry, chin position, and the canting of the occlusal plane was obtained in all patients clinically, as well as radiographically, by the use of intraoral unidirectional distraction osteogenesis.

Three-dimensional facial characteristics of Caucasian infants without cleft and correlation with body measurements

OBJECTIVE

The aim of this study was to characterize the soft tissue facial features of infants without cleft and to report on the correlation between these with weight, length, and head circumference.

DESIGN

This was a prospective study using a noninvasive three-dimensional (3D) stereophotogrammetry (C3D) system to capture the images of the participants. Landmarks were identified on the 3D facial images. Means and SDs were derived for facial distances and angles. A facial asymmetry score was calculated for each image. Two sample Student's t tests, Pearson's correlation coefficients and analysis of covariance were used to ascertain any gender differences and determine whether these could be explained by weight differences.

PARTICIPANTS

Eighty-three infants, 41 boys and 42 girls, were captured at rest with their lips apart, at approximately 3 months of age.

RESULTS

Significant sex differences, of 1 to 2 mm, were found in several facial dimensions, such as face height and nose width. The larger facial measurements correlated significantly with body measurements. Analysis of variance confirmed these differences could be explained by differences in weight. There were no sex differences in the nose/mouth width ratios or in any of the angles measured, suggesting that there may be little sex difference in shape. A slight degree of asymmetry in the faces of infants without cleft was detected.

CONCLUSIONS

Comparisons between noncleft controls and infants with cleft should take cognizance of normal age and sex variations in height and weight that occur among infants.

Dento-skeletal implications of Klippel-Feil syndrome [a case report]

Klippel-Feil syndrome is a disorder characterized by failure of normal segmentation of any two of the seven cervical vertebrae. It presents with a high frequency of cleft lip and/or palate and occasional oligodontia in both the primary and permanent dentition, craniofacial asymmetry, maxillary constriction and velopharyngeal insufficiency.

On the current incidence of deformational plagiocephaly: an estimation based on prospective registration at a single center

In 1992, the American Academy of Pediatrics (AAP) recommended supine sleeping to reduce the risk of sudden infant death syndrome. Although the incidence of deformational plagiocephaly is unknown, the consensus is that it has increased since this recommendation was made. To estimate the current incidence of plagiocephaly, we examined 342 infants for signs of deformational plagiocephaly, including occipital flattening, ear misalignment, frontal bossing, and facial asymmetry. Noticeable occipital flattening was documented in 15.2% of the infants (95% confidence interval, 11.6% to 19.5%); 1.46% had significant cranial deformities that also affected the skull base and face. Significant cranial asymmetry, defined as occipital flattening with concomitant skull base involvement and facial asymmetry, was observed in almost 1 in 68 infants. Adding to a growing body of evidence, our findings suggest significant increases in clinical deformational plagiocephaly since initiation of the AAP's "Back to Sleep" campaign.

Left hemisphere and male sex dominance of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome)

Although radiological findings of cerebral hemiatrophy (Dyke-Davidoff-Masson Syndrome) are well known, there is no systematic study about the gender and the affected side in this syndrome. Brain images in 26 patients (mean aged 11) with cerebral hemiatrophy were retrospectively reviewed. Nineteen patients (73.5%) were male and seven patients (26.5%) were female. Left hemisphere involvement was seen in 18 patients (69.2%) and right hemisphere involvement was seen in eight patients (30.8%). We conclude that male gender and left side involvement are frequent in cerebral hemiatrophy disease.