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Aiyar A, Pedersen TK, Resnick CM, Nørholt SE, Verna C, Stoustrup PB. Management of unilateral craniofacial microsomia with orthopaedic functional appliances: A systematic literature review. Orthod Craniofac Res 2024; 27 Suppl 1:131-140. [PMID: 37987216 DOI: 10.1111/ocr.12729] [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] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
The study aimed to summarize current knowledge regarding the use of orthopaedic functional appliances (OFA) in managing unilateral craniofacial microsomia (UCM). The eligibility criteria for the review were (1) assessing use of OFA as a stand-alone treatment and (2) using OFA in combination during or after MDO. The PICO (population, intervention, comparison and outcome) format formulated clinical questions with defined inclusion and exclusion criteria. No limitations concerning language and publication year were applied. Information sources: A literature search of Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, Web of Science databases without restrictions up to 30 September 2022. The risk of bias was assessed. According to Cochrane and PRISMA guidelines, two independent authors conducted data extraction. The level of evidence for included articles was evaluated based on the Oxford evidence-based medicine database. Due to the heterogeneity of studies and insufficient data for statistical pooling, meta-analysis was not feasible. Therefore, the results were synthesized narratively. A total of 437 articles were retrieved. Of these, nine met inclusion criteria: five assessing OFA and four assessing OFA during or after MDO. There is limited evidence to suggest that stand-alone and combination treatment with OFA is beneficial for treating mild-to-moderate UCM-related dentofacial deformities in short term. No studies assessed the burden of care. In the management of UCM, there is insufficient evidence supporting the efficacy of OFA as a stand-alone treatment or when combined with MDO. Additionally, there is a lack of evidence regarding treatment protocols and the effect on the condyles and the TMJ. The study was registered at Prospero database number CRD42020204969.
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Affiliation(s)
- Akila Aiyar
- Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Thomas Klit Pedersen
- Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Cory M Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus Univerisity, Aarhus, Denmark
| | - Carlalberta Verna
- Department of Paediatric Oral Heath and Orthodontics, University Centre for Dental Medicine UZB University of Basel, Basel, Switzerland
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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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Mehra A, Sarma H. Review of two cutaneous closure methods for Tessier 7 repair: Straight-line versus Z-plasty. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
ABSTRACT Hemifacial microsomia (HFM) is the second most common congenital anomaly of the face after cleft lip and palate. There is a considerable variability in the extent and severity of affection of the bones and soft tissues of the face arising from these two arches. Different classification systems have been described for HFM with the mandible and/or the ear defects being key features needed for any classification system. Nowadays, the most widely used system is the orbital, mandibular, ear, facal nerve, soft tissue (OMENS) classification, later modified to the OMENS+ to include extracraniofacial manifestations.The aim of this study was to review the demographic characteristics and clinical findings of a group of Egyptian patients with HFM and to correlate the findings with data retrieved from the literature.Thirty-nine patients were identified and included in this study. Right side was predominantly affected in 19 patients (48.7%), 9 patients (23%) had left side affection (23%) and 11 patients (28.3%) had bilateral affection, with overall male-to-female ratio of 1:1.4. The majority of patients had a normal orbit (64%), mildly hypoplastic mandible with functioning temporomandibular joint (58% with type M1 or M2a), normal facial nerve (82%), and minimal to mild soft-tissue hypoplasia (52%). Significant ear deformity affected the bigger percentage of the patients (E3: 44%, E2: 14%)The data demonstrate the phenotypic variability of HFM and suggest a degree of relationship among the components of HFM. Some epidemiological aspects and clinical findings in our study did not always parallel those reported in western literatures. Small sample size is the main limitation of the study. Further, and if possible multi-center, studies are recommended.
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Yang IH, Chung JH, Yim S, Cho IS, Lim SW, Kim K, Kim S, Choi JY, Lee JH, Kim MJ, Baek SH. Distribution and phenotypes of hemifacial microsomia and its association with other anomalies. Korean J Orthod 2020; 50:33-41. [PMID: 32042718 PMCID: PMC6995827 DOI: 10.4041/kjod.2020.50.1.33] [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: 08/20/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the distribution and phenotypes of hemifacial microsomia (HFM) and its association with other anomalies. Methods This study included 249 Korean patients with HFM, whose charts, photographs, radiographs, and/or computed tomography scans acquired during 1998–2018 were available from Seoul National University Hospital and Dental Hospital. Prevalence according to sex, side involvement, degree of mandibular deformity, compensatory growth of the mandibular body, and Angle's classification, and its association with other anomalies were statistically analyzed. Results Prevalence was not different between male and female patients (55.0% vs. 45.0%, p > 0.05). Unilateral HFM (UHFM) was more prevalent than bilateral HFM (BHFM) (86.3% vs. 13.7%, p < 0.001). Although distribution of the Pruzansky–Kaban types differed significantly in patients with UHFM (I, 53.0%; IIa, 18.6%; IIb, 24.7%; III, 3.7%; p < 0.001), no difference was observed in occurrence between the right and left sides (52.6% vs. 47.4%, p > 0.05). Among patients with BHFM, prevalence of different Pruzansky–Kaban types on the right and left sides was greater than that of the same type on both sides (67.6% vs. 32.4%, p < 0.05). Despite hypoplasia of the condyle/ramus complex, compensatory growth of the mandibular body on the ipsilateral side occurred in 35 patients (14.1%). Class I and II molar relationships were more prevalent than Class III molar relationships (93.2% vs. 6.8%, p < 0.001). Forty-eight patients (19.3%) had other anomalies, with 50.0% and 14.4% in the BHFM and UHFM groups (p < 0.001). Conclusions Patients with HFM require individualized diagnosis and treatment planning because of diverse phenotypes and associations with other anomalies.
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Affiliation(s)
- Il-Hyung Yang
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Myongji Hospital, College of Medicine, Hanyang University, Goyang, Korea
| | - Sunjin Yim
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea
| | | | - Seung-Weon Lim
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | | | - Sukwha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Myung-Jin Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Private Practice, Seoul, Korea
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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Khorasani H, Boljanovic S, Knudsen MAK, Jakobsen LP. Surgical management of the Tessier 7 cleft: A review and presentation of 5 cases. JPRAS Open 2019; 22:9-18. [PMID: 32158892 PMCID: PMC7061684 DOI: 10.1016/j.jpra.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/04/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Several variations on the surgical technique for macrostomia repair have been described in the literature. There has been controversy regarding the preferred method for commissuroplasty and skin closure for optimal functional and aesthetic results. The aim of this study is to present these techniques and the most described methods up to date.Further, five patients operated with a combination of techniques are presented. MATERIAL AND METHODS PRISMA guidelines were followed for literature review.Five consecutive patients with unilateral macrostomia operated during a period of one and a half years at our craniofacial department were included in this study. RESULTS 31 studies on macrostomia repair were obtained. The layered closure technique is widely described with several variations on closure of the inner mucosa, orbicularis muscle, commissure and skin. The inner mucosal layer is in most cases sutured with a straight line closure technique. The muscle is most often duplicated and sutured with upper branches overlapping lower branches. The skin is in most cases sutured with either a z- or a w-plasty with variations.The five presented patients all had satisfactory functional and aesthetic results at follow-up. CONCLUSION Many variations of surgical techniques for macrostomia repair have been presented in the past. We believe that each case of macrostomia needs to be assessed with a tailored surgical plan in order to create the best results. A combination of different techniques with Bütow and Botha's and Kaplan's technique as a starting point, is believed to give satisfactory functional and aesthetic results.
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Affiliation(s)
- Hoda Khorasani
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Section 2102, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Denmark
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Abstract
Clinicians use different diagnostic terms for patients with underdevelopment of facial features arising from the embryonic first and second pharyngeal arches, including first and second branchial arch syndrome, otomandibular dysostosis, oculoauriculovertebral syndrome, and hemifacial microsomia. Craniofacial microsomia has become the preferred term. Although no diagnostic criteria for craniofacial microsomia exist, most patients have a degree of underdevelopment of the mandible, maxilla, ear, orbit, facial soft tissue, and/or facial nerve. These anomalies can affect feeding, compromise the airway, alter facial movement, disrupt hearing, and alter facial appearance.
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Affiliation(s)
- Craig Birgfeld
- Pediatric Plastic and Craniofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.520, PO Box 5371, Seattle, WA 98105, USA.
| | - Carrie Heike
- Craniofacial Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.528, PO Box 5371, Seattle, WA 98105, USA
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Statistical Analysis Using the OMENS Classification in Oriental Patients With Hemifacial Microsomia. Ann Plast Surg 2014; 72:50-5. [DOI: 10.1097/sap.0b013e3182586c02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Craniofacial microsomia (CFM) is one of the most common congenital conditions treated in craniofacial centers worldwide. This condition is variably associated with anomalies of the jaws, ears, facial soft tissue, orbits, and facial nerve function and can be associated with extracranial anomalies. The cause of this condition is unknown, though CFM has been associated withprenatalexposures and genetic abnormalities. Diagnosis, treatment, and outcome assessment in CFM is challenging due to the wide phenotypic spectrum observed in this condition. Surgical treatment requires a coordinated team approach involving multiple specialties, which can include plastic surgery, craniofacial surgery, orthognathic surgery, and microsurgery. A wide variety of surgical options exist, and individual treatment plans should be based on the patient's needs. Although CFM can be challenging to treat, successful outcomes are rewarding. We provide a review of the common craniofacial surgical treatments for individuals with CFM.
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Affiliation(s)
- Craig B Birgfeld
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington
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Bachelor EP, Kaplan EN. Absence of the lateral canthal tendon in the Treacher-Collins syndrome. BRITISH JOURNAL OF PLASTIC SURGERY 1981; 34:162-4. [PMID: 7236974 DOI: 10.1016/s0007-1226(81)80086-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Walter C. Rekonstruktion der ohrmuschel. Eur Arch Otorhinolaryngol 1972. [DOI: 10.1007/bf00316195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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