Three Demonstrations ON CONGENITAL MALFORMATIONS OF PALATE, FACE, AND NECK: Given at the Royal College of Surgeons, England

The Median Mandibular Symphysis Tessier 30 Cleft:

Atypical craniofacial clefts of the upper facial region have been well documented; however, the mandibular clefts remain rare and reported as isolated case reports. We report a case of a median mandibular cleft within the context of a Tessier 0-14 axis that we have followed over a 5-year period without surgical/orthodontic intervention. The mandibular symphysis cleft remained open without evidence of the fusion, in contrast to ossification of the metopic dysraphism. Within this context, we present a review of the median mandibular cleft cases from 1819 to 2015.

Secondary Dentition Characteristics in Children With Nonsyndromic Unilateral Cleft Lip and Palate

Objective:

Children with cleft lip and palate are reported to be commonly associated with higher prevalence of dental anomalies such as hypodontia, supernumeraries, and abnormalities in tooth size, shape, and position. This study investigated the prevalence of dental anomalies in a longitudinal cohort of children with unilateral cleft lip and palate (UCLP).

Design:

The study was a retrospective analysis of radiographs, study models, and treatment notes.

Patients:

Sixty patients with repaired UCLP aged 13 years old with complete dental records dating from 5 years of age were included.

Methods:

Study casts, dental panoramic, anterior maxillary occlusal, and periapical radiographs of the patients were examined for cleft-sidedness, congenitally missing permanent teeth, supernumerary teeth, microdontic, and macrodontic teeth in the anterior maxillary region, presence of malformed permanent cleft-sided lateral incisor and its morphology (peg-shaped, conical shaped, canine-formed), positions of the permanent lateral incisors relative to the cleft side and presence of rotated cleft-sided central incisors.

Results:

Of the 60 patients studied, 63.3% had hypodontia, 21.7% had supernumerary teeth, 69.6% had microdontia, and 12.5% had macrodontia. All of the cleft-sided permanent lateral incisors had associated anomalies, with a large proportion (43.1%) missing; and when present in 31 subjects, the majority (90.3%) was positioned distal to the cleft. Most of the cleft-sided permanent central incisors were rotated if present, and prevalent at 86.7%.

Conclusion:

A high prevalence of dental anomalies was observed in this sample of children with UCLP.

Accessory Auricles: Systematic Review of Definition, Associated Conditions, and Recommendations for Clinical Practice

Accessory auricles are rare congenital abnormalities embryologically derived from the first branchial arch. Presentation may be variable with locations grouped into anatomical zones based on the frequency of location found in the literature. This study reviewed the papers between 1981 and 2017. Findings included an association with syndromes including Goldenhar, VACTERL, Treacher-Collins, Townes-Brocks, and Wolf-Hirschhorn. Based on histological and embryological evidence, the term "accessory auricle" is best used as an umbrella term to define this difference. Finally, indications are provided for imaging and laboratory investigations to guide the physician treating patients with accessory auricles.

Hypodontia in hemifacial microsomia

OBJECTIVE

The purpose of this study was twofold: (1) to describe the patterns of missing teeth in patients with hemifacial microsomia (HFM) and (2) to compare the prevalence of missing teeth in subjects with HFM with a group of unaffected subjects.

STUDY DESIGN

A descriptive study was conducted comparing HFM subjects with a group of patients selected from an orthodontic clinic.

METHODS

The prevalence of missing teeth was assessed by evaluation of panoramic radiographs. At the time of the study, records of 125 patients with HFM were available from the Craniofacial Center at Boston's Children's Hospital. Seventy-six met inclusion criteria for radiographic analysis of hypodontia. Fifty-two patients met inclusion criteria into the comparison study in which the prevalence of hypodontia was compared with a group of patients from the Department of Orthodontics at Harvard School of Dental Medicine. A Fisher's exact test was conducted to test the hypothesis that HFM patients have a greater prevalence of missing teeth than individuals without the anomaly. A chi-square test for trend was conducted to determine whether hypodontia was more prevalent with increasing severity of the mandibular deformity in HFM.

RESULTS

Hypodontia was more common among HFM patients (26.9%) versus the comparison group in which no missing teeth were recorded (p < .0001). Additionally, the degree of hypodontia was correlated with the grade of mandibular hypoplasia (p = .024).

CONCLUSION

Hypodontia was found to be more prevalent in patients with HFM than in comparison subjects, possibly indicating an etiologic link between the two conditions.

Hemifacial microsomia: extraoral appliance for the early treatment of an infant. Literature review and case report

In this report a description of the different features of hemifacial microsomia is given and a new way of early treatment of concomitant respiratory problems is presented. An extraoral appliance was developed for the treatment of an infant affected with this syndrome. The purpose was to temporarily minimize the child's repeated respiratory disturbances, which were probably caused by glossoptosis, until an autologous costochondral graft in the mandibular ramus could be performed. An improvement of respiration, of facial asymmetry and even a stimulation of mandibular growth was observed. It is claimed that the use of this appliance can help to avoid tracheotomy in many severe cases of uni- or bilateral facial microsomia with glossoptosis and apnea. This treatment should be considered as temporary until the general condition of the patient has improved and grafting is possible.

Surgical treatment of the infected preauricular sinus

Preauricular sinus is a frequent occurring congenital abnormality (circa 0.25% in the white race), but gives mostly no symptoms. In a certain amount of cases symptoms can arise as recurring purulent secretion or a preauricular abscess. If the disease is recognized an adequate therapy can be accomplished. Sometimes the disease is not recognized and diagnosed as a sebaceous cyst or a furunculus. Also, if the sinus is recognized, it is necessary not to underestimate the disease. In several clinical studies a recurrencerate of 15--33% is quoted. Singer published in 1966 a technique of extirpation of the infected preauricular sinus with excellent results. This technique was adopted with addition of the use of the operating microscope. In nine patients with an infected preauricular sinus extirpation in toto was accomplished in a silent period. Under these nine patients were two recurrences after previous inadequate surgery. After a minimal follow-up of 2 years the patients were symptom-free. The quoted technique of extirpation of the infected preauricular sinus in toto seems to be an improvement for the therapeutic armamentarium.

Congenital aural and pre-auricular sinuses in the South African Bantu

The incidence of ear pits was studied in the South African Bantu population. A short account of the anatomy, occurrence, inheritance, developmental origin, complications and treatment of this anomaly was given. Mention has been made of the clinical significance and the possible association between ear pits and other systemic and ear abnormalities, including deafness. There seems to be a higher incidence of other abnormalities in children born with sinuses. The blanket term 'pre-auricular fistula' should possibly be discarded in favour of auricular sinuses or ear pits.