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Rakshit Vijay Sinai Khandeparker - One of the best experts on this subject based on the ideXlab platform.
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a retrospective analysis of complications associated with tooth borne anterior Maxillary distraction for managing cleft Maxillary Hypoplasia a 12 year experience
Journal of Cranio-maxillofacial Surgery, 2020Co-Authors: Sunil Richardson, Rakshit Vijay Sinai KhandeparkerAbstract:Abstract Purpose To evaluate the intra- and post-operative complications of tooth-borne anterior Maxillary distraction in management of cleft Maxillary Hypoplasia over a 12-year period, and to establish whether the procedure involves a learning curve. Materials and methods All patients with cleft Maxillary Hypoplasia satisfying the inclusion and exclusion criteria and undergoing anterior Maxillary distraction with a tooth-borne palatal distractor between June 2007 to June 2018 were retrospectively studied by retrieving their individual medical records, which included radiographic (lateral cephalogram analysis at three different intervals) and speech assessment records. The presence of intra- and post-operative complications developing in this study period was noted. Furthermore, the frequency of intra- and post-operative complications occurring from years 2007–2018 were evaluated to study whether there was a decrease in the frequency of complications with increasing time. This was done to establish whether there was a learning curve associated with the surgical procedure. The results thus obtained were tabulated using SPSS 25.0 (SPSS Inc., Chicago, IL) and subjected to statistical analysis using the chi-squared test. A p value of less than 0.05 was considered statistically significant. Results Out of the 458 patients included in the study, 78.82 % (n = 361) had no complications. In the remaining 97 patients, a total of 137 complications (46 intra-operative and 91 post-operative) were observed, making up for a complication rate of 21.17%. The intra-operative complications noted were appliance dislodgement (n = 19), palatal mucosal tears (n = 12), hemorrhage (n = 8), dental injuries (n = 6) and inadvertent fracture of the anterior segment (n = 1). The post-operative complications noted were anterior open bite (n = 24), gingival inflammation (n = 14), appliance dislodgement (n = 13), dental injuries (n = 10), relapse (n = 8), hemorrhage (n = 5), soft tissue infections (n = 4), palatal fistula (n = 3), speech impairment (n = 3), wound dehiscence not related to infection (n = 3), need for re-operation (n = 2), avascular necrosis of the anterior segment (n = 1) and Maxillary sinusitis (n = 1). A statistically significant decrease (p Conclusion Tooth-borne anterior Maxillary distraction in managing cleft Maxillary Hypoplasia is associated with a wide range of complications: some avoidable and related to surgeon's experience; some related to the surgical procedure itself; and some unavoidable and related to the distractor appliance. Understanding potential complications allows the surgeon to ensure safe care through early intervention and to correctly inform the patient in the pre-operative discussion. The procedure involves a learning curve before it can be accomplished safely without many complications.
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a comprehensive management protocol to treat cleft Maxillary Hypoplasia
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Sunil Richardson, Shreya Krishna, Rakshit Vijay Sinai KhandeparkerAbstract:Abstract Aim To describe a comprehensive management protocol to treat cleft Maxillary Hypoplasia specific to the patient's age, degree of Hypoplasia and presence or absence of velopharyngeal incompetence (VPI). Materials and methods A total of 359 patients suffering from cleft Maxillary Hypoplasia were retrospectively studied from January 2004 till June 2015. Lateral cephalograms were taken to assess the degree of deformity and advancement achieved at three intervals. Patients were treated by four treatment modalities: Facemask therapy, Anterior Maxillary advancement, Total Maxillary osteogenesis and LeFort I advancement. Results 359 patients of cleft Maxillary Hypoplasia were treated and followed up for a mean of 25 ± 3.6 months. Group I had 20 patients, all in the pre-pubertal age group with less than 11 mm discrepancy. 25% of patients in this group had relapse; Group II: 196 patients who were all above 11 years of age and included all grades of Hypoplasia, only 6.25% patients had relapse; Group III had 36 patients all with severe form of Hypoplasia and were above 5 years of age. Relapse in this group was 16.6%; Group IV had 102 patients who were above 16 years of age and had mildmoderate severity of Hypoplasia. Relapse rate was 18.75%. Conclusion Extensive literature search and our institutional study has helped us formulate a protocol that delineates the most appropriate treatment modality for a specific age group and degree of Hypoplasia also considering the effect of treatment on velopharyngeal incompetence.
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tooth borne anterior Maxillary distraction for cleft Maxillary Hypoplasia our experience with 147 patients
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Sunil Richardson, Rakshit Vijay Sinai Khandeparker, Nikkie S Seelan, Dhivakar Selvaraj, Shweta RichardsonAbstract:Purpose To evaluate the results of anterior Maxillary distraction for its efficacy and long-term stability in the management of cleft Maxillary Hypoplasia in a large series of patients with a long-term follow-up extending to 4 years. Materials and Methods One hundred sixty-four patients at least 10 years old with cleft Maxillary Hypoplasia who presented to the authors' unit from January 2009 through October 2014 were evaluated retrospectively, irrespective of gender, type of cleft lip and palate, and amount of advancement needed. Anterior Maxillary distraction using a tooth-borne distractor appliance was carried out in all patients and all patients were followed up to 4 years (range, 1 to 4 yr) to evaluate the stability of the procedure and to document any relapse using digitalized lateral cephalograms taken before distraction, immediately after distraction (T2), and at the last follow-up visit (T3; range, 1 to 4 yr). Seventeen patients were subsequently lost to follow-up; therefore, a complete set of records was available for 147 patients. In a subset of 50 patients, perceptual speech assessment was carried out preoperatively and 6 months postoperatively by 2 speech pathologists using the Perkins scoring system that allowed the evaluation of 5 parameters (velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility). None of these patients underwent speech therapy during the course of evaluation. The development of complications intra- or postoperatively was noted. The data were tabulated and analyzed. Results An advancement ranging from 4.0 to 13.1 mm (mean, 9.42 mm) was achieved in all patients. One hundred forty patients (95.23%) showed stable results on lateral cephalograms and when T2 values were compared with T3 values. Seven patients (4.76%) exhibited skeletal relapse in various linear and angular measurements assessed on lateral cephalograms. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). An overall complication rate of 25.17% (n = 37) was noted, with bleeding being the most common intra- and postoperative complication noted in 15 patients (10.2%). No serious consequences related to any complication were noted. Conclusion Anterior Maxillary distraction can be considered a suitable treatment option for the management of mild to moderate cleft Maxillary Hypoplasia because the anteroposterior deficiency can be addressed at a young age, immediately after the eruption of the Maxillary second premolars. Stable long-term results with negligible skeletal relapse are possible with this technique, with an added advantage of unhampered or even improved velopharyngeal function.
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perceptual speech assessment after anterior Maxillary distraction in patients with cleft Maxillary Hypoplasia
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Sunil Richardson, Rakshit Vijay Sinai Khandeparker, Nikkie S Seelan, Dhivakar Selvaraj, Sangeetha GnanamonyAbstract:Purpose To assess speech outcomes after anterior Maxillary distraction (AMD) in patients with cleft-related Maxillary Hypoplasia. Materials and Methods Fifty-eight patients at least 10 years old with cleft-related Maxillary Hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant. Results Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant ( P ≤ .001). Conclusion AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment.
Alvaro A. Figueroa - One of the best experts on this subject based on the ideXlab platform.
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long term skeletal stability after Maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft Maxillary deformities
Plastic and Reconstructive Surgery, 2004Co-Authors: Alvaro A. Figueroa, John W. Polley, Hans FriedeAbstract:Rigid external distraction is a highly effective technique for correction of Maxillary Hypoplasia in patients with orofacial clefts. The clinical results after correction of sagittal Maxillary deformities in both the adult and pediatric age groups have been stable. The purpose of this retrospective longitudinal cephalometric study was to review the long-term stability of the repositioned maxilla in cleft patients who underwent Maxillary advancement with rigid external distraction. Between April 1, 1995, and April 1, 1999, 17 consecutive patients with cleft Maxillary Hypoplasia underwent Maxillary advancement using rigid external distraction. There were 13 male patients and four female patients, with ages ranging from 5.2 to 23.6 years (mean, 12.6 years). After a modified complete high Le Fort I osteotomy and a latency period of 3 to 5 days, patients underwent Maxillary advancement with rigid external distraction until proper facial convexity and dental overjet and overbite were obtained. After active distraction, a 3- to 4-week period of rigid retention was undertaken; this was followed by removable elastic retention for 6 to 8 weeks using, during sleep time, an orthodontic protraction face mask. Cephalometric radiographs were obtained preoperatively, after distraction, at 1 year after distraction, and 2 or more years after distraction. The mean follow-up was 3.3 years (minimum, 2.1 years; maximum, 5.3 years). The following measurements were obtained in each cephalogram: three linear horizontal and two linear vertical Maxillary measurements, two angular cranioMaxillary measurements, and one craniomandibular measurement. Differences between the preoperative and postoperative cephalometric values were analyzed by paired t tests (p < 0.05). The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla. In addition, the mandibular plane angle opened 1.2 degrees after surgery. After the 1- to 3-year follow-up period, the maxilla was stable in the sagittal plane. Minimal anteroposterior growth was observed in the maxilla compared with that exhibited in the anterior cranial base. However, there was significant vertical Maxillary growth over the 3-year observation period. The mandibular plane angle tended to decrease during the follow-up period. The cephalometric data from this study support the clinical impression of Maxillary stability after Maxillary advancement with rigid external distraction in cleft patients. This effective and stable technique is now considered for all pediatric patients with severe cleft Maxillary Hypoplasia and for adolescent and adult patients with moderate to severe deformities.
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Maxillary distraction for the management of cleft Maxillary Hypoplasia with a rigid external distraction system.
Seminars in orthodontics, 1999Co-Authors: Alvaro A. Figueroa, John W. PolleyAbstract:Abstract Maxillary Hypoplasia is a common finding in patients with repaired orofacialclefts. Management of this condition has been a challenge to the reconstructive team. The introduction of distraction osteogenesis to treat craniofacial skeletal dysplasias has opened alternative approaches to manage these severe conditions. In this article, the authors present their technique to distract the hypoplastic cleft maxilla using a rigid external distraction device. The clinical assessment, indications, orthodontic procedure, surgical technique, and distraction protocol are reviewed. A case report shows the use of the technique. This technique allows the reconstructive team to treat patients in all age groups with predictable and stable results.
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rigid external distraction its application in cleft Maxillary deformities
Plastic and Reconstructive Surgery, 1998Co-Authors: John W. Polley, Alvaro A. FigueroaAbstract:Patients with severe Maxillary deficiency secondary to orofacial clefting present multiple challenging problems for the reconstructive team. These patients exhibit multidimensional Maxillary Hypoplasia and skeletal clefting with absence of Maxillary and alveolar bone, as well as scarring, residual fistulas, and dental anomalies. Traditional surgical/orthodontic approaches to treat these patients, while sometimes successful in obtaining stable occlusal relationships, often fall short of expectations with respect to facial balance and aesthetics. The application of Maxillary distraction osteogenesis in the treatment protocol of patients with severe maxillofacial anomalies offers a powerful alternative for the reconstructive team.
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management of severe Maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external adjustable rigid distraction device
Journal of Craniofacial Surgery, 1997Co-Authors: John W. Polley, Alvaro A. FigueroaAbstract:We present our technique for Maxillary distraction osteogenesis in patients with severe Maxillary Hypoplasia. With the use of an external, adjustable, rigid distraction device, we can now treat patients with severe Maxillary Hypoplasia with a precise and controlled distraction process, obtaining predictable results. This technique has allowed us to treat patients in all age groups. In this report we review our indications for Maxillary distraction and describe our technique using an external, adjustable, rigid midface distraction device.
Sunil Richardson - One of the best experts on this subject based on the ideXlab platform.
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a retrospective analysis of complications associated with tooth borne anterior Maxillary distraction for managing cleft Maxillary Hypoplasia a 12 year experience
Journal of Cranio-maxillofacial Surgery, 2020Co-Authors: Sunil Richardson, Rakshit Vijay Sinai KhandeparkerAbstract:Abstract Purpose To evaluate the intra- and post-operative complications of tooth-borne anterior Maxillary distraction in management of cleft Maxillary Hypoplasia over a 12-year period, and to establish whether the procedure involves a learning curve. Materials and methods All patients with cleft Maxillary Hypoplasia satisfying the inclusion and exclusion criteria and undergoing anterior Maxillary distraction with a tooth-borne palatal distractor between June 2007 to June 2018 were retrospectively studied by retrieving their individual medical records, which included radiographic (lateral cephalogram analysis at three different intervals) and speech assessment records. The presence of intra- and post-operative complications developing in this study period was noted. Furthermore, the frequency of intra- and post-operative complications occurring from years 2007–2018 were evaluated to study whether there was a decrease in the frequency of complications with increasing time. This was done to establish whether there was a learning curve associated with the surgical procedure. The results thus obtained were tabulated using SPSS 25.0 (SPSS Inc., Chicago, IL) and subjected to statistical analysis using the chi-squared test. A p value of less than 0.05 was considered statistically significant. Results Out of the 458 patients included in the study, 78.82 % (n = 361) had no complications. In the remaining 97 patients, a total of 137 complications (46 intra-operative and 91 post-operative) were observed, making up for a complication rate of 21.17%. The intra-operative complications noted were appliance dislodgement (n = 19), palatal mucosal tears (n = 12), hemorrhage (n = 8), dental injuries (n = 6) and inadvertent fracture of the anterior segment (n = 1). The post-operative complications noted were anterior open bite (n = 24), gingival inflammation (n = 14), appliance dislodgement (n = 13), dental injuries (n = 10), relapse (n = 8), hemorrhage (n = 5), soft tissue infections (n = 4), palatal fistula (n = 3), speech impairment (n = 3), wound dehiscence not related to infection (n = 3), need for re-operation (n = 2), avascular necrosis of the anterior segment (n = 1) and Maxillary sinusitis (n = 1). A statistically significant decrease (p Conclusion Tooth-borne anterior Maxillary distraction in managing cleft Maxillary Hypoplasia is associated with a wide range of complications: some avoidable and related to surgeon's experience; some related to the surgical procedure itself; and some unavoidable and related to the distractor appliance. Understanding potential complications allows the surgeon to ensure safe care through early intervention and to correctly inform the patient in the pre-operative discussion. The procedure involves a learning curve before it can be accomplished safely without many complications.
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use of repeat anterior Maxillary distraction to correct residual midface Hypoplasia in cleft patients
Journal of The Korean Association of Oral and Maxillofacial Surgeons, 2017Co-Authors: Sunil Richardson, Shreya Krishna, Avi BansalAbstract:Objectives: The study was designed to evaluate the efficacy of performing a second, repeat anterior Maxillary distraction (AMD) to treat residual cleft Maxillary Hypoplasia. Materials and Methods: Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft Maxillary Hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft Maxillary Hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons. Results: At the time of presentation, a residual Maxillary Hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean Maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (P=0.012, P=0.011, and P=0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed. Conclusion: Addressing the problem of cleft Maxillary Hypoplasia at an early age (12-15 years) is beneficial for the child. Residual Hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.
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a comprehensive management protocol to treat cleft Maxillary Hypoplasia
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Sunil Richardson, Shreya Krishna, Rakshit Vijay Sinai KhandeparkerAbstract:Abstract Aim To describe a comprehensive management protocol to treat cleft Maxillary Hypoplasia specific to the patient's age, degree of Hypoplasia and presence or absence of velopharyngeal incompetence (VPI). Materials and methods A total of 359 patients suffering from cleft Maxillary Hypoplasia were retrospectively studied from January 2004 till June 2015. Lateral cephalograms were taken to assess the degree of deformity and advancement achieved at three intervals. Patients were treated by four treatment modalities: Facemask therapy, Anterior Maxillary advancement, Total Maxillary osteogenesis and LeFort I advancement. Results 359 patients of cleft Maxillary Hypoplasia were treated and followed up for a mean of 25 ± 3.6 months. Group I had 20 patients, all in the pre-pubertal age group with less than 11 mm discrepancy. 25% of patients in this group had relapse; Group II: 196 patients who were all above 11 years of age and included all grades of Hypoplasia, only 6.25% patients had relapse; Group III had 36 patients all with severe form of Hypoplasia and were above 5 years of age. Relapse in this group was 16.6%; Group IV had 102 patients who were above 16 years of age and had mildmoderate severity of Hypoplasia. Relapse rate was 18.75%. Conclusion Extensive literature search and our institutional study has helped us formulate a protocol that delineates the most appropriate treatment modality for a specific age group and degree of Hypoplasia also considering the effect of treatment on velopharyngeal incompetence.
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tooth borne anterior Maxillary distraction for cleft Maxillary Hypoplasia our experience with 147 patients
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Sunil Richardson, Rakshit Vijay Sinai Khandeparker, Nikkie S Seelan, Dhivakar Selvaraj, Shweta RichardsonAbstract:Purpose To evaluate the results of anterior Maxillary distraction for its efficacy and long-term stability in the management of cleft Maxillary Hypoplasia in a large series of patients with a long-term follow-up extending to 4 years. Materials and Methods One hundred sixty-four patients at least 10 years old with cleft Maxillary Hypoplasia who presented to the authors' unit from January 2009 through October 2014 were evaluated retrospectively, irrespective of gender, type of cleft lip and palate, and amount of advancement needed. Anterior Maxillary distraction using a tooth-borne distractor appliance was carried out in all patients and all patients were followed up to 4 years (range, 1 to 4 yr) to evaluate the stability of the procedure and to document any relapse using digitalized lateral cephalograms taken before distraction, immediately after distraction (T2), and at the last follow-up visit (T3; range, 1 to 4 yr). Seventeen patients were subsequently lost to follow-up; therefore, a complete set of records was available for 147 patients. In a subset of 50 patients, perceptual speech assessment was carried out preoperatively and 6 months postoperatively by 2 speech pathologists using the Perkins scoring system that allowed the evaluation of 5 parameters (velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility). None of these patients underwent speech therapy during the course of evaluation. The development of complications intra- or postoperatively was noted. The data were tabulated and analyzed. Results An advancement ranging from 4.0 to 13.1 mm (mean, 9.42 mm) was achieved in all patients. One hundred forty patients (95.23%) showed stable results on lateral cephalograms and when T2 values were compared with T3 values. Seven patients (4.76%) exhibited skeletal relapse in various linear and angular measurements assessed on lateral cephalograms. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in velopharyngeal insufficiency, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). An overall complication rate of 25.17% (n = 37) was noted, with bleeding being the most common intra- and postoperative complication noted in 15 patients (10.2%). No serious consequences related to any complication were noted. Conclusion Anterior Maxillary distraction can be considered a suitable treatment option for the management of mild to moderate cleft Maxillary Hypoplasia because the anteroposterior deficiency can be addressed at a young age, immediately after the eruption of the Maxillary second premolars. Stable long-term results with negligible skeletal relapse are possible with this technique, with an added advantage of unhampered or even improved velopharyngeal function.
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perceptual speech assessment after anterior Maxillary distraction in patients with cleft Maxillary Hypoplasia
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Sunil Richardson, Rakshit Vijay Sinai Khandeparker, Nikkie S Seelan, Dhivakar Selvaraj, Sangeetha GnanamonyAbstract:Purpose To assess speech outcomes after anterior Maxillary distraction (AMD) in patients with cleft-related Maxillary Hypoplasia. Materials and Methods Fifty-eight patients at least 10 years old with cleft-related Maxillary Hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant. Results Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant ( P ≤ .001). Conclusion AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment.
Juan C Zenteno - One of the best experts on this subject based on the ideXlab platform.
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Nasopalpebral lipoma-coloboma syndrome: clinical, radiological, and histopathological description of a novel sporadic case.
American journal of medical genetics. Part A, 2013Co-Authors: Oscar F Chacon-camacho, Monica S Lopez-martinez, Johanna Vázquez, Angel Nava-castañeda, Fernando Martin-biasotti, Raul E Piña-aguilar, Marisol Iñiguez-soto, Job Acosta-garcía, Juan C ZentenoAbstract:Nasopalpebral lipoma-coloboma syndrome is an extremely uncommon autosomal dominant condition characterized by congenital upper eyelid and nasopalpebral lipomas, colobomata of upper and lower eyelids, telecanthus, and Maxillary Hypoplasia. A few familial and sporadic cases of this malformation syndrome have been previously reported. Here, the clinical, radiological, and histopathological features of a sporadic Mexican patient with the nasopalpebral lipoma-coloboma syndrome are described. To our knowledge, this is the first time that craniofacial 3D computed tomography imaging was used for a detailed assessment of the facial lipoma.
John W. Polley - One of the best experts on this subject based on the ideXlab platform.
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long term skeletal stability after Maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft Maxillary deformities
Plastic and Reconstructive Surgery, 2004Co-Authors: Alvaro A. Figueroa, John W. Polley, Hans FriedeAbstract:Rigid external distraction is a highly effective technique for correction of Maxillary Hypoplasia in patients with orofacial clefts. The clinical results after correction of sagittal Maxillary deformities in both the adult and pediatric age groups have been stable. The purpose of this retrospective longitudinal cephalometric study was to review the long-term stability of the repositioned maxilla in cleft patients who underwent Maxillary advancement with rigid external distraction. Between April 1, 1995, and April 1, 1999, 17 consecutive patients with cleft Maxillary Hypoplasia underwent Maxillary advancement using rigid external distraction. There were 13 male patients and four female patients, with ages ranging from 5.2 to 23.6 years (mean, 12.6 years). After a modified complete high Le Fort I osteotomy and a latency period of 3 to 5 days, patients underwent Maxillary advancement with rigid external distraction until proper facial convexity and dental overjet and overbite were obtained. After active distraction, a 3- to 4-week period of rigid retention was undertaken; this was followed by removable elastic retention for 6 to 8 weeks using, during sleep time, an orthodontic protraction face mask. Cephalometric radiographs were obtained preoperatively, after distraction, at 1 year after distraction, and 2 or more years after distraction. The mean follow-up was 3.3 years (minimum, 2.1 years; maximum, 5.3 years). The following measurements were obtained in each cephalogram: three linear horizontal and two linear vertical Maxillary measurements, two angular cranioMaxillary measurements, and one craniomandibular measurement. Differences between the preoperative and postoperative cephalometric values were analyzed by paired t tests (p < 0.05). The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla. In addition, the mandibular plane angle opened 1.2 degrees after surgery. After the 1- to 3-year follow-up period, the maxilla was stable in the sagittal plane. Minimal anteroposterior growth was observed in the maxilla compared with that exhibited in the anterior cranial base. However, there was significant vertical Maxillary growth over the 3-year observation period. The mandibular plane angle tended to decrease during the follow-up period. The cephalometric data from this study support the clinical impression of Maxillary stability after Maxillary advancement with rigid external distraction in cleft patients. This effective and stable technique is now considered for all pediatric patients with severe cleft Maxillary Hypoplasia and for adolescent and adult patients with moderate to severe deformities.
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Maxillary distraction for the management of cleft Maxillary Hypoplasia with a rigid external distraction system.
Seminars in orthodontics, 1999Co-Authors: Alvaro A. Figueroa, John W. PolleyAbstract:Abstract Maxillary Hypoplasia is a common finding in patients with repaired orofacialclefts. Management of this condition has been a challenge to the reconstructive team. The introduction of distraction osteogenesis to treat craniofacial skeletal dysplasias has opened alternative approaches to manage these severe conditions. In this article, the authors present their technique to distract the hypoplastic cleft maxilla using a rigid external distraction device. The clinical assessment, indications, orthodontic procedure, surgical technique, and distraction protocol are reviewed. A case report shows the use of the technique. This technique allows the reconstructive team to treat patients in all age groups with predictable and stable results.
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rigid external distraction its application in cleft Maxillary deformities
Plastic and Reconstructive Surgery, 1998Co-Authors: John W. Polley, Alvaro A. FigueroaAbstract:Patients with severe Maxillary deficiency secondary to orofacial clefting present multiple challenging problems for the reconstructive team. These patients exhibit multidimensional Maxillary Hypoplasia and skeletal clefting with absence of Maxillary and alveolar bone, as well as scarring, residual fistulas, and dental anomalies. Traditional surgical/orthodontic approaches to treat these patients, while sometimes successful in obtaining stable occlusal relationships, often fall short of expectations with respect to facial balance and aesthetics. The application of Maxillary distraction osteogenesis in the treatment protocol of patients with severe maxillofacial anomalies offers a powerful alternative for the reconstructive team.
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management of severe Maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external adjustable rigid distraction device
Journal of Craniofacial Surgery, 1997Co-Authors: John W. Polley, Alvaro A. FigueroaAbstract:We present our technique for Maxillary distraction osteogenesis in patients with severe Maxillary Hypoplasia. With the use of an external, adjustable, rigid distraction device, we can now treat patients with severe Maxillary Hypoplasia with a precise and controlled distraction process, obtaining predictable results. This technique has allowed us to treat patients in all age groups. In this report we review our indications for Maxillary distraction and describe our technique using an external, adjustable, rigid midface distraction device.