ABSTRACTS BACHMAYER DI, Ross RB, Munro IR. Maxillary Growth
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ABSTRACTS BACHMAYER DI, Ross RB, Munro IR. Maxillary growth following Lefort III advancement surgery in Crouzon, Apert, and Pfeiffer syndromes. Am J Orthod Dentofac Orthop 1987; 90:420-430. The authors studied facial growth following Le Fort III osteotomies in 19 children with Crouzon (7), Apert (10), and Pfeiffer (2) syndromes. The group containing 12 males and 7 females with a mean age of 7.1 years at surgery were followed an average of 5.3 years after the surgeries. The authors compared the operated syn- drome group with a group of 52 unoperated syndrome patients: Crouzon (26); Apert (23), and Pfeiffer (3). They also compared the operated group with normative data from the University of Michigan School Growth Study. The authors found that the horizontal growth of the maxilla of the operated syndrome group was negligible (less than 0.1 mm/year) and different from the unoperated syndrome group (0.7 mm/year) and the normal group (1.3 mm/year). The authors found that vertical growth of the maxilla was similar in all three groups. They concluded that the surgery was justifiable, even though a subsequent maxillary advancement is required after growth is completed. (Staley) Reprints: Dr. R. Bruce Ross Head, Division of Orthodontics The Hospital for Sick Children 555 University Avenue Toronto, Ontario MSG 1X8 FRIEDE H, FIGUEROA AA, NAEGELE ML, GoUuLp HJ, Kay CN, Apuss H. Craniofacial growth data for cleft lip patients infancy to 6 years of age: potential applications. Am J Orthod Dentofac Orthop 1986; 90:388-409. The authors provide longitudinal roentgencephalometric growth data on a group of 38 cleft lip only and 34 cleft lip and alveolus subjects from infancy to 6 years of age. Of the 72 subjects studied, 44 were male and 28 female. The authors reported findings on 35 variables. The data represent a unique view of craniofacial growth during this early period of postnatal growth. (Staley) Reprints: Dr. Howard Aduss Center for Craniofacial Anomalies University of Illinois College of Medicine at Chicago P.O. Box 6998 Chicago, IL 60680 GUvYyoT JP, GaCEK RR. The temporal bone anomaly in CHARGE association. Arch Otolaryngol 1987; 113:321-324. Final anatomic diagnoses in the fifth reported case attributed to CHARGE Association, a female, age 7 months, included: retinal coloboma, status post ligation ductus arteriosis and cardiomegaly, bronchopneumo- nia, patient choanae, no palate defect, and brain stem gliosis and neuronal loss consistent with neonatal anox- ia. The tympanic membrane, malleus, incus, middle ear, and the stapes head, neck, and crural arches were well formed, but unattached to the undeveloped footplate. Temporal bone findings included normal cochlear and vestibular nuclei, Mondini type pars inferior dysplasia, and aplasia of the pars superior. All reported CHARGE Association patients have normal chromosome studies and negative family history for genetic trans- mission. Anomalies in this association indicate a development defect 35 and 45 days after conception, suggest- ing to the authors a teratogenic effect during the formation, proliferation, and migration of cephalic neural crest cells. Because CHARGE Association patients have longer life expectancy than those with other severe congenital syndromes, cochlear implantation for auditory rehabilitation is explored. (Gregg) Reprints: Dr. R.R. Gacek Department of Otolaryngology and Communication Sciences State University of New York Upstate Medical Center 750 E. Adams Street Syracuse, NY 13210 2534 aBstracts 255 - HarpIn MA, Morris HL, Van DEMARK DR. A study of cleft palate speakers with marginal velopharyngeal competence. J Commun Disord 1986; 19:461-473. __ The purpose of this study was to determine whether a proposed subgroup of patients with marginal velopharyngeal incompetence could be identified on the basis of lateral still radiograph findings alone. Pa- tients in the subgroup, referred to as ''Almost-But-Not-Quite'' (ABNQ), were described as clinically demon- strating (1) consistent but slight nasalization of speech, (2) no improvement in response to auditory-visual stimulation of nasalized speech production errors, (3) touch closure or very small velopharyngeal opening on still lateral radiographs, and (4) manometric ratios between 0.70 and 0.90, indicating slight velopharyn- geal dysfunction. A total of 52 subjects between the ages of 5.5 and 6.5 years who demonstrated a **velopharyn- geal space of less than two millimeters'' or "touch or doubtful closure" on lateral still radiographs were identified. Of these 52 subjects, none were found who met all of the stated clinical criteria for inclusion in the proposed ABNQ subgroup. In fact, 24 of 52 demonstrated velopharyngeal competence. Only one subject demonstrated consistent nasal distortion of pressure consonants, and only four subjects were not stimulable. The authors concluded that the ABNQ subgroup may exist, but that it may not be possible to identify the subgroup on the basis of single lateral radiographs or, for that matter, on the basis of any single estimate of velopharyngeal efficiency. Alternatively, they allowed for the possibility that the subgroup does not exist as proposed. Other strategies are suggested for investigating subgroups of patients who demonstrate marginal velopharyngeal incompetence. (Karnell) Reprints: Dr. Hughlett L. Morris Department of Otolaryngology-Head and Surgery University of Iowa Hospitals and Clinics University of Iowa Iowa City, IO 52242 HorstROM H. Surgical correction of the nose and midface in maxillonasal dysplasia (Binder's syn- drome). Plast Reconstr Surg 1986; 78:568-580. The usual surgical treatment for maxillofacial dysplasia consisted of wide section of the nasal attachments from the face, correcting a retruded nasal base with onlay cancellous bone grafts, all through an oral vestibular approach. This study reports that nasal dorsum is corrected by an 'L' shaped bone graft from the iliac crest introduced through the same approach. Septal advancement was used in some patients in whom the bony nasal dorsum was otherwise adequate. There was no mention of facial bone osteotomies. The patient satisfaction result was high. (Lindsay) Reprints: Dr. Hans Holstrom Department of Plastic Surgery Sahlgrenska Hospital 413 45 Goteborg Sweden HormstrRom H. Clinical and pathological features of maxillonasal dysplasia (Binders syndrome): significance of the prenasal fossa on etiology. Plast Reconstr Surg 1986; 78:559-567. Fifty patients with maxillonasal dysplasia (Binder's syndrome) have been studied clinically and pathologi- cally in detail. A palpable depression in the anterior nasal floor (fossa prenasalis) is considered to be the basic skeletal deformity, together with local localized maxillary hypoplasia in the alar base regions. Class III maloc- clusion was found in 54 percent of patients. There was a hereditary connection in 16 percent of the patients. The paper contains interesting thoughts on the etiology of this condition. (Lindsay) Reprints: Dr. Hans Holstrom Department of Plastic Surgery Sahlgrenska Hospital 413 45 Goteborg Sweden 256 Cleft Palate Journal, July 1987, Vol. 24 No. 3 IsBERG A, HENNINGSSON G. Influence of palatal fistulas on velopharyngeal movements: a cineradio- graphic study. Plast Reconstr Surg 1987; 79:525-530. This article from the Karolinska Institute, Stockholm, is a study of ten patients, three isolated CP and seven complete unilateral CLCP patients with hard palate fistulas varying between 4.5 and 26 mm and velopharyn- geal incompetence. The patients were examined cineradiographically with their fistulas open and then covered by chewing gum. With the fistula covered, the velopharyngeal movements improved or became normal in all patients, regardless of fistula size. These studies indicate the importance of closing or covering the fistula. Only if velopharyngeal incompetence persists after a temporary covering of the fistula should a combination of velopharyngeal flap surgery and a fistula closure be performed. (Lindsay) Reprints: Dr. Annika Isberg Department of Oral Radiology Karolinska Institute PO. Box 4064 S-141 04 Hudding Sweden JacKksoN IT, ApHAM MN. Metallic plate stabilization of bone grafts in craniofacial surgery. Br J Plast Surg 1986; 39: 341-344. The authors report their experience of metallic plate osteosynthesis in the stabilization of bone grafts after osteotomies for frontal advancement, orbital deformities, and Le Fort III procedures. The instrumentation al- lows simultaneous stabilization of the osteotomy and bone grafting, resulting in a dramatic reduction in operat- ing time. It also allows a very accurate fit of the bone graft into the defect. The fixation is sufficiently rigid to allow removal of all intermaxillary fixation at the end of maxillary osteotomies, and it is also suggested that this type of fixation may reduce subsequent relapse rates. (Ward) . Reprints: Dr. Ian T. Jackson Section of Plastic and Reconstructive Surgery Mayo Clinic Rochester, MN 55905 JacomBson BN, RosEnstTEIN SW. Cleft Lip and palate: the orthodontist's youngest patlent Am J Orthod Dentofac Orthop 1987; 90:63-66 The authors describe a method to construct a maxillary appliance to be inserted shortly after birth. The appliance is thought to simulate the hard palate, thus improving feeding and also providing passive support for the lateral segments of the maxillary arch. Thus the efforts of the muscular forces of the newly repaired lip are minimized. The authors indicated that the success of the treatment is dependent on the retention of the appliance,