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Atiba PM, Omotoso BR, Madaree A, Lazarus L. Hemifacial microsomia: a scoping review on progressive facial asymmetry due to mandibular deformity. Oral Maxillofac Surg 2024:10.1007/s10006-024-01276-5. [PMID: 38954312 DOI: 10.1007/s10006-024-01276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This scoping review explores various parameters of the mandible in progressive facial asymmetry (FA) in hemifacial microsomia (HFM) patients, highlighting its relationship with sex, population, and age group. METHODS The review was based on a comprehensive search of PubMed, EBSCOhost, and Web of Science. Eligible studies that met the inclusion criteria form part of the selection study. The included studies were appraised using screening and quantitative criteria of mixed-method appraisal tools. The authors utilised a pre-set data extraction form to obtain information from the included studies. RESULTS Eleven studies met the inclusion criteria. The mandible parameters used were angular measurements, chin point, ramal height, body length, and total length. There was no relationship between FA and sex in HFM patients in the included studies. Most of the studies were comprised of European participants (55%), followed by Americans (36%) and Chinese (9%). The age groups included in the selected studies were categorised as dentition age (18%), early-to-middle childhood (18%), and varied ages (64%). The data presented in this review only pertains to the anomalous characteristics recorded on the affected side in HFM patients. No concomitant control data was recorded in this review. CONCLUSION An assessment of the included studies revealed that FA does not increase with age in HFM. Hence, FA is non-progressive in HFM patients. This information is relevant to diagnosing and managing HFM patients. More reports are needed on the progression of FA in HFM patients.
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Affiliation(s)
- Peterson Makinde Atiba
- Discipline of Clinical Anatomy, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
- Anatomy Programme, Faculty of Basic Medical and Health Sciences, College of Health Sciences, Bowen University, Iwo, Osun State, Nigeria
| | - Bukola Rukayat Omotoso
- Discipline of Clinical Anatomy, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Anil Madaree
- Department of Plastic and Reconstructive Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Lelika Lazarus
- Discipline of Clinical Anatomy, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.
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Kaprio L, Grann A, Leikola J, Saarikko A, Kurimo J, Kiukkonen A. Non-progressive mandibular changes in children with Type I and II craniofacial microsomia. Orthod Craniofac Res 2024; 27 Suppl 1:122-130. [PMID: 37822212 DOI: 10.1111/ocr.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/30/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To describe the mandibular growth of craniofacial microsomia (CFM) patients during early childhood to adolescence with attention to symmetry. MATERIALS AND METHODS Altogether 61 CFM patients were studied at the Cleft Palate and Craniofacial Center, Helsinki University Hospital between 1986 and 2006. In this cohort study, we measured and analysed 293 radiographs (posteroanterior, panoramic and lateral); 165 radiographs of 40 patients met the final inclusion criteria. The vertical height of the ramus in anteroposterior and panoramic radiographs, the length of the mandible in anteroposterior radiographs and the maxillary protrusion and mandibular retrognathia in lateral cephalograms were measured in four different age groups. RESULTS A statistical difference existed between the groups in the vertical height of the ramus and in the mandibular length. The vertical height of the ramus measured from the panoramic radiograph grew on both sides, and the ratios remained unchanged. In the sagittal dimension, the maxilla and mandible grew forward, but no significant differences emerged between the groups. CONCLUSIONS Results suggest that mild-type CFM is not progressive in nature. During growth, mandibular asymmetry measured in the horizontal, vertical and sagittal planes did not increase.
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Affiliation(s)
- Laura Kaprio
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annemari Grann
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Saarikko
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Kurimo
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Anu Kiukkonen
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Niikura Y, Ishii T, Sakamoto Y, Ariizumi D, Sakamoto T, Sueishi K. Assessment and Identification of Improvement Areas for Facial Symmetry in Hemifacial Microsomia (Type IIB) Using Three-dimensional Measurements. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5877. [PMID: 38859809 PMCID: PMC11164012 DOI: 10.1097/gox.0000000000005877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/17/2024] [Indexed: 06/12/2024]
Abstract
Background Surgical planning for hemifacial microsomia (HFM) patients often involves planning the amount of maxillary movement and mandibular bone distraction from three-dimensional (3D) volumetric images constructed from computed tomography scans. By representing anatomical indicators for facial symmetry in X, Y, and Z coordinates, we identified the more challenging areas in correcting facial asymmetry. Methods The study included five HFM patients with a mean age of 22.2 years, all diagnosed with HFM (type IIB). We established measurement points with high reproducible 3D coordinates on the 3D volumetric images obtained from computed tomography scans for before surgery, treatment objectives, and after surgery. We assessed the symmetry of measurement points between the affected side and nonaffected side at each time point. Results In the before-surgery group, significant differences were observed between the affected side and nonaffected side in X,Y (excluding Palatine foramen, upper molar, canine) and Z coordinates for measurement items. In the treatment objectives group, no differences were observed between the affected side and nonaffected side in X, Y, and Z coordinates, resulting in facial symmetry. In the after-surgery group, significant differences were observed in Y coordinates in the mental foramen area, and significant differences were observed in z axis measurement items in the canine and mental foramen areas. Conclusions It is evident that relying solely on a front view assessment is insufficient to achieve facial symmetry. Particularly, both anterior-posterior and vertical improvements in the area near the mental foramen on the affected side are necessary.
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Affiliation(s)
- Yoichiro Niikura
- From the Department of Orthodontics, Tokyo Dental College, Tokyo, Japan
| | - Takenobu Ishii
- From the Department of Orthodontics, Tokyo Dental College, Tokyo, Japan
- Department of Orthodontics, Tokyo Dental College Chiba Dental Centre, Chiba, Japan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Dai Ariizumi
- From the Department of Orthodontics, Tokyo Dental College, Tokyo, Japan
| | - Teruo Sakamoto
- Department of Orthodontics, Tokyo Dental College Chiba Dental Centre, Chiba, Japan
| | - Kenji Sueishi
- From the Department of Orthodontics, Tokyo Dental College, Tokyo, Japan
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Huh J, Park JS, Sodnom-Ish B, Yang HJ. Growth characteristics and classification systems of hemifacial microsomia: a literature review. Maxillofac Plast Reconstr Surg 2024; 46:18. [PMID: 38733452 PMCID: PMC11088588 DOI: 10.1186/s40902-024-00427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Hemifacial microsomia is characterized by the hypoplasia of the mandible and temporomandibular joint, involving a variety of abnormalities of the craniofacial area. Since it gradually worsens as patients grow, it is necessary to understand the characteristics of facial bone growth and facial deformity in hemifacial microsomia patients in order to determine appropriate treatment timing and treatment methods. MAIN BODY Appropriate classification of hemifacial microsomia would facilitate accurate diagnosis, selection of treatment methods, and prognosis prediction. Therefore, in this article, we review previously published hemifacial microsomia classification and provide an overview of the growth of the facial skeleton and the characteristics of hemifacial microsomia-related facial deformities. The OMENS system is the most comprehensive classification method based on the characteristics of hemifacial microsomia deformity, but it needs to be improved to include malar/midface abnormalities and nerve involvement. In hemifacial microsomia, growth is progressing on the affected side, but to a lesser degree than the unaffected side. Therefore, surgical intervention in growing patients should be performed selectively according to the severity of deformity. CONCLUSION Understanding growth patterns is important to develop appropriate treatment protocols for correcting asymmetry in adult patients and to minimize secondary anomalies in growing patients.
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Affiliation(s)
- Joonyoung Huh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Ji-Song Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Buyanbileg Sodnom-Ish
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
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Shu KY, Liu W, Zhao JL, Zhang ZY, Shan BG, Li XY, Ma LK. Condylar resorption post mandibular distraction osteogenesis in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023; 51:675-681. [PMID: 37852887 DOI: 10.1016/j.jcms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.
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Affiliation(s)
- Kai-Yi Shu
- Department of Medical Cosmetology and Plastic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Liu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiu-Li Zhao
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Yong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ba-Ga Shan
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Yuan Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lun-Kun Ma
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yang Y, Zhao Z, Pan B, Yu X. Morphologic Variability of Bone and Soft Tissue in Microtia With Hemifacial Microsomia. EAR, NOSE & THROAT JOURNAL 2023:1455613231197768. [PMID: 37735888 DOI: 10.1177/01455613231197768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Objective: Microtia patients with hemifacial microsomia (HFM) have a host of distinct anatomical disorder of skeletal and soft tissue asymmetries. The purpose of this study was to assess soft tissue discrepancies in microtia patients with HFM and their correlation with skeletal discrepancies. Methods: A total of 42 patients were enrolled and studied prospectively using a 3-dimensional superimposition and color mapping of the soft and hard tissues. Mirroring techniques created perfectly symmetric models for comparison. Differences between affected and normal sides were evaluated in 5 areas: retroauricular mastoid, malar, maxillary frontal, mandibular frontal, and gonion areas. Pearson correlations were used to assess the relationship between skeletal and soft tissue asymmetry. Results: Hard tissue asymmetry ranged from 0.79 mm (mandibular frontal) to 1.29 mm (malar), while soft tissue asymmetry ranged from 1.34 mm (maxillary frontal) to 5.26 mm (retroauricular mastoid). Correlations between skeletal and soft tissue asymmetry varied, with the strongest correlation observed at the retroauricular mastoid area and the weakest at the maxillary frontal area. Conclusion: There was a high correlation between bone and soft tissue hypoplasia at the retroauricular mastoid area, while the other evaluated areas showed poor correlation between skeletal and soft tissue asymmetries. Clinicians should assess each component separately for optimal treatment planning in microtia patients with HFM.
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Affiliation(s)
- Yang Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhao Zhao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bo Pan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaobo Yu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Morphologic Changes of the Temporomandibular Joint in Pruzansky-Kaban Type IIa Hemifacial Microsomia Postmandibular Distraction Osteogenesis. J Craniofac Surg 2023; 34:591-596. [PMID: 36857566 DOI: 10.1097/scs.0000000000008854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/10/2022] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Mandibular distraction osteogenesis (MDO) is a powerful tool for the correction of hemifacial microsomia (HFM). The temporomandibular joint (TMJ) is the focus of attention in the diagnosis and treatment of HFM. This observational retrospective cross-sectional study aimed to investigate morphologic changes in TMJ post-MDO in type IIa HFM. METHODS We recruited 48 patients with unilateral type IIa HFM who had completed MDO and mandibular distractor extraction (MDE). Data relating to the length, distance, angle, and volume of the TMJ were measured on 3-dimension models created by the analysis of computed tomography data. Normality analysis was performed by using the Shapiro-Wilk test. Data were compared with the paired t test and Wilcoxon signed-ranks test. RESULTS The spaces between the affected condyle and the affected glenoid fossa before MDO were all significantly larger than before MDE (P<0.05). The breadth of the affected glenoid fossa before MDO was significantly longer than before MDE (P<0.001). The height of the affected condyle before MDO was significantly longer than before MDE (P<0.001). The volume of the affected condyle before MDO was significantly larger than before MDE (P<0.001). The ratio between the volume of the affected condyle and unaffected condyle before MDO was 0.20±0.13. The ratio between the volume of the affected condyle before MDE and MDO was 0.65±0.32. The resorption rate of the affected condyle post-MDO was 0.35±0.32. CONCLUSION Herein, we characterized anatomic changes of the TMJ in type- IIa HFM post-MDO. Condylar resorption and the compression of space between the condyle and the glenoid fossa on the affected side were 2 typical manifestations. Our findings enhanced the understanding of the application of MDO on HFM.
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Zhang Z, Chen X, Kim BS, Han W, Yan Y, Wang X, Li X, Zhang Y, Chai G. Quantitative structural analysis of hemifacial microsomia mandibles in different age groups. Front Pediatr 2023; 11:1157607. [PMID: 37138574 PMCID: PMC10149722 DOI: 10.3389/fped.2023.1157607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction This study aims to quantitively analyze mandibular ramus and body deformities, assessing the asymmetry and progression in different components. Methods This is a retrospective study on hemifacial microsomia children. They were divided into mild/severe groups by Pruzansky-Kaban classification and into three age groups (<1 year,1-5 years, 6-12 years old). Linear and volumetric measurements of the ramus and the body were collected via their preoperative imaging data to compare between the different sides and severities, using independent and paired tests, respectively. The progression of asymmetry was assessed by changes in affected/contralateral ratios with age using multi-group comparisons. Results Two hundred and ten unilateral cases were studied. Generally, the affected ramus and body were significantly smaller than those on the contralateral side. Linear measurements on the affected side were shorter in the severe group. Regarding affected/contralateral ratios, the body was less affected than the ramus. Progressively decreased affected/contralateral ratios of body length, dentate segment volume, and hemimandible volume were found. Discussion There were asymmetries in mandibular ramus and body regions, which involved the ramus more. A significant contribution to progressive asymmetry from the body suggests treatment focus in this region.
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Renkema RW, van Beelen I, Koudstaal MJ, Caron CJJM. The effect of natural growth on chin point deviation in patients with unilateral craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2022; 50:615-620. [PMID: 35872040 DOI: 10.1016/j.jcms.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/27/2021] [Accepted: 07/12/2022] [Indexed: 10/17/2022] Open
Abstract
This study aimed to investigate the potential progressiveness of mandibular asymmetry and to study factors that influence chin point deviation in patients with unilateral craniofacial microsomia (CFM). Paediatric patients with unilateral CFM with available radiologic imaging and medical photographs were included. Chin point deviation was measured on clinical photographs. A Jonckheere-Terpstra test and linear mixed model for repeated measurements assessed the relation of chin point deviation on natural growth, Pruzansky-Kaban score, and soft tissue score. A total of 110 patients were included. The linear mixed model showed no statistically significant changes of chin point deviation during growth (effect estimate -0.006°, 95% CI -0.04° to -0.03°, p = 0.74). A statistical significant relation between both the Pruzansky-Kaban and soft tissue score on chin point deviation was found (effect estimate -5.10°, 95% CI -6.45° to -3.75°, p ≤ 0.001 and effect estimate -3.42°, CI -5.86° to -0.98°, p ≤ 0.001, respectively). Within the limitations of the study it seems that craniofacial microsomia may be a non-progressive disorder, because chin point deviation did not change over time.
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Affiliation(s)
- Ruben W Renkema
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, the Netherlands.
| | - Irene van Beelen
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, the Netherlands
| | - Maarten J Koudstaal
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, the Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, the Netherlands
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Xie Y, Zeng R, Yan J, Yan T, Tan J. Introducing surface-to-surface matching technique to evaluate mandibular symmetry: A retrospective study. Heliyon 2022; 8:e09914. [PMID: 35855982 PMCID: PMC9287795 DOI: 10.1016/j.heliyon.2022.e09914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study introduced a three-dimensional (3D) surface-to-surface matching technique to evaluate the mandibular symmetry of teenagers and adults with unilateral second molar scissor bite. Methods The targets came from 73 cone-beam computed tomography (CBCT) images with unilateral second molar scissor bite, including teenagers (n = 30) and adults (n = 43). 73 images without scissor bite and matched in sex and age were selected as controls. The scans were developed into 3D mandible models and seven mandibular functional unit models, including condylar process (Co), coronoid process (Cr), mandibular ramus (Ra), mandibular angle (Ma), alveolar process (Ap), mandibular body (Mb) and chin process (Ch). The surface-to-surface matching technique was introduced. 3D deviation analysis and matching percentages calculation were performed and compared to evaluate the symmetry of the mandible. Results Comparisons were made between the study samples and control samples. For teenagers, the matching percentages of the entire mandible (55.31 ± 7.24%), Mb (69.04 ± 9.22%) and Co (65.19 ± 10.67%) in the study group were lower than that of the entire mandible (60.87 ± 6.38%) (P <0.01), Mb (75.0 ± 8.71%) (P <0.05) and Co (70.25 ± 8.20%) (P <0.05) in the control group. While Ap, Ra, Ch, Cr and Ma showed no statistically significant differences (P >0.05). For adults, the matching percentages of the entire mandible (48.88 ± 9.77%), Ap (65.83 ± 11.21%), Mb (64.43 ± 12.03%), Ch (79.17 ± 10.29%), Ra (64.11 ± 9.84%) and Co (61.08 ± 11.64%) in the study group were lower than the entire mandible (59.28 ± 5.49%) (P <0.01), Ap (73.65 ± 9.10%) (P <0.01), Mb (71.66 ± 8.40%) (P <0.01), Ch (83.86 ± 5.59%) (P <0.05), Ra (68.54 ± 7.87%) (P <0.05) and Co (66.20 ± 10.62%) (P <0.05) of the control group. Only Cr and Ma showed no statistically significant differences (P >0.05). Conclusion Mandibular asymmetry was observed in both teenagers and adults with unilateral second molar scissor bite. Moreover, compared with teenagers, more mandibular units of adult patients were affected. Clinical significance Based on the surface-to-surface matching technique, the symmetric and morphological information of the mandible can be converted into visual color maps and quantitative descriptions. This method can bring convenience to the study of the growth of mandible, orthodontic treatment and orthognathic surgery design.
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Affiliation(s)
- Yajuan Xie
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Runling Zeng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Jiayin Yan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Tong Yan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Jiali Tan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
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Jeong SH, Woo MW, Shin DS, Yeom HG, Lim HJ, Kim BC, Yun JP. Three-Dimensional Postoperative Results Prediction for Orthognathic Surgery through Deep Learning-Based Alignment Network. J Pers Med 2022; 12:998. [PMID: 35743782 PMCID: PMC9225553 DOI: 10.3390/jpm12060998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/13/2022] Open
Abstract
To date, for the diagnosis of dentofacial dysmorphosis, we have relied almost entirely on reference points, planes, and angles. This is time consuming, and it is also greatly influenced by the skill level of the practitioner. To solve this problem, we wanted to know if deep neural networks could predict postoperative results of orthognathic surgery without relying on reference points, planes, and angles. We use three-dimensional point cloud data of the skull of 269 patients. The proposed method has two main stages for prediction. In step 1, the skull is divided into six parts through the segmentation network. In step 2, three-dimensional transformation parameters are predicted through the alignment network. The ground truth values of transformation parameters are calculated through the iterative closest points (ICP), which align the preoperative part of skull to the corresponding postoperative part of skull. We compare pointnet, pointnet++ and pointconv for the feature extractor of the alignment network. Moreover, we design a new loss function, which considers the distance error of transformed points for a better accuracy. The accuracy, mean intersection over union (mIoU), and dice coefficient (DC) of the first segmentation network, which divides the upper and lower part of skull, are 0.9998, 0.9994, and 0.9998, respectively. For the second segmentation network, which divides the lower part of skull into 5 parts, they were 0.9949, 0.9900, 0.9949, respectively. The mean absolute error of transverse, anterior-posterior, and vertical distance of part 2 (maxilla) are 0.765 mm, 1.455 mm, and 1.392 mm, respectively. For part 3 (mandible), they were 1.069 mm, 1.831 mm, and 1.375 mm, respectively, and for part 4 (chin), they were 1.913 mm, 2.340 mm, and 1.257 mm, respectively. From this study, postoperative results can now be easily predicted by simply entering the point cloud data of computed tomography.
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Affiliation(s)
- Seung Hyun Jeong
- Advanced Mechatronics R&D Group, Korea Institute of Industrial Technology (KITECH), Gyeongsan 38408, Korea; (S.H.J.); (M.W.W.)
| | - Min Woo Woo
- Advanced Mechatronics R&D Group, Korea Institute of Industrial Technology (KITECH), Gyeongsan 38408, Korea; (S.H.J.); (M.W.W.)
- School of Computer Science and Engineering, Kyungpook National University, Daegu 41566, Korea
| | - Dong Sun Shin
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon 35233, Korea; (D.S.S.); (H.J.L.)
| | - Han Gyeol Yeom
- Department of Oral and Maxillofacial Radiology, Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon 35233, Korea;
| | - Hun Jun Lim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon 35233, Korea; (D.S.S.); (H.J.L.)
| | - Bong Chul Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon 35233, Korea; (D.S.S.); (H.J.L.)
| | - Jong Pil Yun
- Advanced Mechatronics R&D Group, Korea Institute of Industrial Technology (KITECH), Gyeongsan 38408, Korea; (S.H.J.); (M.W.W.)
- KITECH School, University of Science and Technology, Daejeon 34113, Korea
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Renkema RW, Caron CJJM, Heike CL, Koudstaal MJ. A decade of clinical research on clinical characteristics, medical treatments, and surgical treatments for individuals with craniofacial microsomia: What have we learned? J Plast Reconstr Aesthet Surg 2022; 75:1781-1792. [PMID: 35365411 DOI: 10.1016/j.bjps.2022.02.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
AIM This article provides a review of a decade of clinical research studies on clinical features, medical interventions, and surgical interventions for individuals with craniofacial microsomia (CFM). We also provide recommendations for future clinical research. METHOD A systematic search of literature was conducted in Embase and PubMed/MEDLINE Ovid. All publications from 2010 to 2020 that included at least 10 individuals with CFM were considered relevant for this study. RESULTS A total of 91 articles were included. In the past decade, many new studies on CFM have been published providing more insight on the diagnosis and management of patients with CFM. This review encompasses findings on the clinical difficulties patients with CFM encounter, including the craniofacial and extracraniofacial characteristics of patients with CFM and its related clinical consequences on breathing, feeding, speech, and hearing. CONCLUSIONS A considerable number of large multicenter studies have been published in recent years, providing new insights in the clinical consequences of CFM. The phenotypic variety between patients with CFM makes patient-specific treatment tailored to individual needs essential. The research and development of clinical care standards might be challenging because of the heterogeneity of CFM. Future research on clinical and patient-reported outcomes can help identify optimal treatment strategies. Cooperation between craniofacial centers, using uniform registration and outcome measurement tools, could enhance research and future care for these patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ruben W Renkema
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland.
| | - Cornelia J J M Caron
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland
| | - Carrie L Heike
- Seattle Children's Craniofacial Center, Seattle, United States
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland
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Coelho J, Armelim Almiro P, Nunes T, Kato R, Garib D, Miguéis A, Corte-Real A. Sex and age biological variation of the mandible in a Portuguese population- a forensic and medico-legal approaches with three-dimensional analysis. Sci Justice 2021; 61:704-713. [PMID: 34802644 DOI: 10.1016/j.scijus.2021.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
The medico-legal identification is based on a set of discriminatory characteristics between individuals in their biological, social, cultural, religious, legal and economic framework. The purpose of this study was to characterize the biological variation, regarding gender and age, in a Portuguese population. A three-dimensional (3D) analysis of 215 mandibles (7-20 years old) from the database of the Laboratory of Forensic Dentistry, Faculty of Medicine, University of Coimbra (CE-112/2019) was performed. A total of 13 cephalometric points defined 10 linear variables and 7 angular variables, on 3D reconstructions from ConeBeam Computed Tomography (CBCT) images. Intra and inter-observer errors were analyzed by Technical Measurement Error test. A descriptive statistics was performed. To verify the influence of gender and age on the variables and to determine its predictive value, ANOVA and Logistic Regression Analysis were performed. Gender and age influence most of the linear variables, however, the same is not true for angular variables. In the analysis of all variables, the model has a reasonable level of sensitivity (67.8%) according to gender. For the age prediction, with all variables, the model presented a reasonable level of sensitivity, classifying 79.4% of the individuals. The results supported, with a high level of statistical significance, an adequate recognition of individuals highlighting the identification and criminal imputability of Portuguese individuals.
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Affiliation(s)
- Joana Coelho
- Anatomy Institute, Faculty of Medicine, University of Coimbra, Portugal; Forensic Dentistry Laboratory, Faculty of Medicine, University of Coimbra, Portugal.
| | - Pedro Armelim Almiro
- Autonomous University of Lisbon (UAL), CIP-UAL, CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
| | - Tiago Nunes
- Forensic Dentistry Laboratory, Faculty of Medicine, University of Coimbra, Portugal
| | - Renata Kato
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.
| | - Daniela Garib
- Orthodontist and Professor. Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies and Bauru Dental School, University of São Paulo, Bauru, SP, Brazil.
| | - António Miguéis
- Anatomy Institute, Faculty of Medicine, University of Coimbra, Portugal.
| | - Ana Corte-Real
- Forensic Dentistry Laboratory, Faculty of Medicine, University of Coimbra, Portugal.
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Correlations Between Mandible Condylar Structures and External Ear Deformities in Hemifacial Microsomia With Three-Dimensional Analysis. J Craniofac Surg 2021; 33:1154-1158. [PMID: 34743153 DOI: 10.1097/scs.0000000000008342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study aimed to explore correlations between mandible and ear deformities and quantitative volumetric relations between condylar structures and external ear in hemifacial microsomia. The authors reconstructed three-dimensional craniofacial models from 212 patients with unilateral hemifacial microsomia (the unaffected side as the controls). Patients were evaluated by Pruzansky-Kaban and Marx classification, and divided into 3 age groups (0-6, 7-12, and >12 years old). The mandible condylar structures, including condyle and the condylar skeletal unit, were selected (except the classification of the mandibular or ear deformities (M3)). Along with the external ear (except the classification of the mandibular or ear deformities (E4)), their volumes were measured and analyzed. Spearman correlation coefficient analysis was applied. There was a positive correlation between the mandible and ear deformities (r = 0.301, P < 0.001). Either between the condyle and external ear (P = 0.071-0.493) or between the condylar unit and external ear (P = 0.080-0.488), there were no volumetric relations on the affected side, whereas on the unaffected side were (r = 0.492-0.929 for condyle, r = 0.443-0.929 for the condylar unit, P < 0.05). In most cases, the condylar structures of the classification of the mandibular or ear deformities (M2b) were significantly smaller than the classification of the mandibular or ear deformities (M2a). Results suggested deformities of mandibular condylar structures and ear did not correlate, although deformities of mandible and ear did. The condylar deformity might develop independently from microtia and be more severe within relatively more abnormal temporomandibular joints.
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Using orthodontic elastic traction during the active period of distraction osteogenesis to increase the effective vertical extension of hemifacial microsomia patients: A multi-center randomized clinical trial. J Craniomaxillofac Surg 2021; 49:1054-1063. [PMID: 34404588 DOI: 10.1016/j.jcms.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/28/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022] Open
Abstract
In this study, the aim was to assess whether using elastic traction during the active period of distraction osteogenesis could effectively increase the vertical extension. Patients with Pruzansky-Kaban Type II mandibular deformity were recruited and randomly assigned into Elastic traction + Distraction Osteogenesis group or Distraction Osteogenesis group, respectively. During the active period, the experimental group received orthodontic elastic traction 3 days after distraction osteogenesis implantation, while the control group received no treatment. All the participants underwent computed tomography (CT) examination before surgery, at the end of the active period, 6 months and 2 years after distraction osteogenesis tractor implantation. The primary outcome was the effective vertical extension rate of the mandible from the baseline to the end of the active period after operations, and there were 7 secondary outcomes used. 70 patients were included. The effective vertical extension rates were 85.021% ± 7.432% (mean ± SD) and 68.811% ± 9.510% (mean ± SD) in the experimental and control groups, respectively (P = 0.001). The average distances between the lower middle incisor point to the sagittal plane at the end of the active period were 2.485 ± 1.411 mm and 3.938 ± 2.293 mm in the experimental and control groups, respectively (P = 0.026). At the end of the active period of distraction osteogenesis, the average values of the mandibular occlusal plane canting were -4.887 ± 3.126 mm and -0.177 ± 4.029 mm in the experimental and control groups, respectively (P = 0.026). Elastic traction-assisted distraction osteogenesis could improve traction efficiency and facial symmetry.
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Chen YF, Vinayahalingam S, Bergé S, Liao YF, Maal T, Xi T. Three-Dimensional Analysis of the Condylar Hypoplasia and Facial Asymmetry in Craniofacial Microsomia Using Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2021; 79:1750.e1-1750.e10. [PMID: 33939960 DOI: 10.1016/j.joms.2021.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the condylar hypoplasia and its correlation with craniofacial deformities in adults with unilateral craniofacial microsomia (CFM). METHODS Pretreatment cone-beam computed tomography scans of consecutive adults (mean age: 20.4 ± 3.0 years; range: 17.3 to 31.4 years) with Pruzansky-Kaban type I and IIA CFM were reconstructed in 3D. Both condyles were segmented. Asymmetry ratios (affected side/contralateral side) of condylar volume were calculated to indicate the extent of condylar hypoplasia. 3D cephalometry was performed to quantify the maxillomandibular morphology and facial asymmetry. The correlations in between were assessed by using Pearson's or Spearman's correlation coefficients. RESULTS Thirty-six subjects were enrolled, consisting of 22 subjects with Pruzansky-Kaban type I and 14 subjects with type IIA. The condyles in type IIA group were significantly more hypoplastic in height (asymmetry ratio: 40.69 vs 59.95%, P = .006) and volume (18.16 vs 47.84%, P < .001) compared to type I group. Type IIA group had a significantly smaller SNB value than type I group (72.94° vs 77.41°, P = .012), and a significantly greater facial asymmetry (P < .05). The hypoplastic extent of condylar volume and Pruzansky-Kaban types were significantly correlated with SNB (r = 0.457 and ρ = -0.411, respectively), upper incisor deviation (r = -0.446 and ρ = 0.362), chin deviation (r = -0.477 and ρ = 0.527), upper occlusal plane cant (r = -0.672 and ρ = 0.631), and mandibular plane cant (r = -0.557 and ρ = 0.357, P < .05). CONCLUSION For unilateral CFM adults, greater condylar hypoplasia in volume along with more severe mandibular retrusion and facial asymmetry objectively indicated a higher scale of Pruzansky-Kaban classification (type IIA). These quantitative distinctions are expected to enhance the diagnostic reliability of CFM.
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Affiliation(s)
- Yun-Fang Chen
- Assistant Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shankeeth Vinayahalingam
- PhD candidate, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Professor, Department head, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yu-Fang Liao
- Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Professor, Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Thomas Maal
- Professor, Director, Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tong Xi
- Surgeon, Research coordinator, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Jeong SH, Yun JP, Yeom HG, Kim HK, Kim BC. Deep-Learning-Based Detection of Cranio-Spinal Differences between Skeletal Classification Using Cephalometric Radiography. Diagnostics (Basel) 2021; 11:591. [PMID: 33806132 PMCID: PMC8064489 DOI: 10.3390/diagnostics11040591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to reveal cranio-spinal differences between skeletal classification using convolutional neural networks (CNNs). Transverse and longitudinal cephalometric images of 832 patients were used for training and testing of CNNs (365 males and 467 females). Labeling was performed such that the jawbone was sufficiently masked, while the parts other than the jawbone were minimally masked. DenseNet was used as the feature extractor. Five random sampling crossvalidations were performed for two datasets. The average and maximum accuracy of the five crossvalidations were 90.43% and 92.54% for test 1 (evaluation of the entire posterior-anterior (PA) and lateral cephalometric images) and 88.17% and 88.70% for test 2 (evaluation of the PA and lateral cephalometric images obscuring the mandible). In this study, we found that even when jawbones of class I (normal mandible), class II (retrognathism), and class III (prognathism) are masked, their identification is possible through deep learning applied only in the cranio-spinal area. This suggests that cranio-spinal differences between each class exist.
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Affiliation(s)
- Seung Hyun Jeong
- Safety System Research Group, Korea Institute of Industrial Technology (KITECH), Gyeongsan 38408, Korea; (S.H.J.); (J.P.Y.)
| | - Jong Pil Yun
- Safety System Research Group, Korea Institute of Industrial Technology (KITECH), Gyeongsan 38408, Korea; (S.H.J.); (J.P.Y.)
| | - Han-Gyeol Yeom
- Department of Oral and Maxillofacial Radiology, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon 35233, Korea;
| | - Hwi Kang Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon 35233, Korea;
| | - Bong Chul Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon 35233, Korea;
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18
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Apostolopoulos K, Bous RM, ElNaghy R, Kumar AR, Valiathan M. Examining the variability of bone and soft tissue morphology in Hemifacial Microsomia: A case series of 8 patients. J Craniomaxillofac Surg 2021; 49:352-357. [PMID: 33612409 DOI: 10.1016/j.jcms.2021.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/08/2020] [Accepted: 02/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIM OF THE STUDY Patients with Hemifacial Microsomia (HFM) exhibit highly variable skeletal and soft tissue asymmetries. The purpose of this study was to evaluate soft tissue discrepancies in patients with HFM and correlate them to the skeletal discrepancy. Eight patients were selected and studied retrospectively using 3-dimensional (3D) superimposition and color mapping of the soft and hard tissues. The skeletal and soft tissue facial structures were segmented and mirrored, resulting in a perfectly symmetric skull and face. Original and mirrored 3D models were superimposed. Differences between the affected and normal side were assessed in seven areas: frontal, endocanthion, exocanthion, malar, maxillary frontal, mandibular frontal and gonion area. The correlations between the skeletal and soft tissue asymmetry were evaluated by Pearson correlations. Hard tissue asymmetry ranged from 1.4 mm (Endocanthion) to 5.5 mm (Gonion), while soft tissue asymmetry ranged from 1.5 mm (Endocanthion) to 5.6 mm (Malar). Correlation between skeletal and soft tissue deficiency were highly variable, with the highest correlation at gonion and the lowest at exocanthion. Bone and soft tissue hypoplasia were highly correlated at the gonion and the malar area, while the remaining evaluated areas demonstrated poor correlation between skeletal and soft tissue asymmetries. Future studies will determine if target treatment can reliably improve bone and soft tissue hypoplasia in this area.
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Affiliation(s)
- Konstantinos Apostolopoulos
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Rany M Bous
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Rahma ElNaghy
- Department of Orthodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA.
| | - Anand R Kumar
- Division of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Manish Valiathan
- Department of Craniofacial and Special Care Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Remy F, Godio-Raboutet Y, Captier G, Bonnaure P, Burgart P, Guyot L, Thollon L. The Hypoplasic Mandible: What Makes it Different From the Healthy Child? Cleft Palate Craniofac J 2020; 58:966-973. [PMID: 33167677 DOI: 10.1177/1055665620972301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. METHOD Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. RESULTS The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 - P value = 1.64e-3 for the height of the left ramus versus 0.18 ± 4.18 - P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). CONCLUSIONS Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.
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Affiliation(s)
- Floriane Remy
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France.,YooMed, Montpellier, France
| | | | - Guillaume Captier
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Montpellier, France
| | | | | | - Laurent Guyot
- Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery, A.P.-H.M., North University Hospital, Marseille, France.,Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France
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Chen YF, Baan F, Bruggink R, Bronkhorst E, Liao YF, Ongkosuwito E. Three-dimensional characterization of mandibular asymmetry in craniofacial microsomia. Clin Oral Investig 2020; 24:4363-4372. [PMID: 32382927 PMCID: PMC7666680 DOI: 10.1007/s00784-020-03302-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/17/2020] [Indexed: 01/20/2023]
Abstract
Objectives This study aimed to investigate the three-dimensional (3D) mandibular asymmetry in craniofacial microsomia (CFM) and its association with the Pruzansky–Kaban classification system. Materials and methods Cone-beam computed tomography images of 48 adult CFM cases were collected. The asymmetry of the mandibular body and ramus was analyzed with 3D landmarks. The mirrored mandibular model was registered on the original model, yielding a color-coded distance map and an average distance (i.e., asymmetry score) to quantify the overall mandibular asymmetry. Results The lengths of the mandibular body and ramus were significantly shorter on the affected than the contralateral side (p < 0.001). The ANB (p = 0.009), body and ramal lengths (both p < 0.001), and body and ramal length asymmetry (both p < 0.05) were significantly different between mild (types I/IIA) and severe (types IIB/III) cases. The mandibular asymmetry score correlated with mandibular body length asymmetry (r = 0.296, p = 0.046). CFM mandibles showed high variability in shape asymmetry. Conclusions CFM patients showed distinct body and ramal length asymmetries. In severe cases, mandibles were smaller, more retruded, and more asymmetric in length. The mandibular shape asymmetry was highly variable regardless of the Pruzansky–Kaban types, being a determinant in the extent of overall mandibular asymmetry. Clinical relevance The 3D morphologic analysis provides better insights into real mandibular asymmetry. Although the Pruzansky–Kaban classification was applied, high individual variability of the mandibular morphology still existed within the types. Therefore, individualized analyses and treatment plans for CFM patients are highly recommended.
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Affiliation(s)
- Yun-Fang Chen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.,Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Frank Baan
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Bruggink
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3DLab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Section of Preventive and Restorative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yu-Fang Liao
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.,Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Edwin Ongkosuwito
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands. .,Amalia Cleft and Craniofacial Centre, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Treatment approaches to syndromes affecting craniofacial and dental structures. J World Fed Orthod 2019. [DOI: 10.1016/j.ejwf.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mun SH, Park M, Lee J, Lim HJ, Kim BC. Volumetric characteristics of prognathic mandible revealed by skeletal unit analysis. Ann Anat 2019; 226:3-9. [PMID: 31336151 DOI: 10.1016/j.aanat.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to evaluate the skeletal units of a normal mandible (class I) and a prognathic mandible (class III), to compare the groups, and to investigate the key functional unit responsible for mandibular prognathism. Hemi-mandibles of 101 cases were evaluated by cone-beam computed tomography. Of these, 50 cases had Class I and 51 had Class III mandibles. The length, volume, and volume/length ratio of each skeletal unit were measured. The ratios of the condyle, body unit, and sum of the hemi-mandible between Class I and Class III showed statistically significant results (P<0.05). However, the ratios of angle, coronoid, and symphysis units did not show any statistical significance on comparison. Dependent on gender, in males the ratio of the condyle of the hemi-mandible showed statistically significant results (P<0.05). Meanwhile in females the ratio of the body and sum of the hemi-mandible showed statistically significant results (P<0.05). Accordingly, the mandibular body and condylar units are thinner in mandibular prognathism. On the basis of the functional matrix theory to determine the aetiology of mandibular prognathism, the key skeletal units are the body and condylar units.
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Affiliation(s)
- Seong Ho Mun
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Mira Park
- Department of Preventive Medicine, Eulji University, Daejeon, Republic of Korea
| | - Jun Lee
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Hun Jun Lim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Bong Chul Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea.
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