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Jesse A Taylor - One of the best experts on this subject based on the ideXlab platform.
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Assessing the Midface in Muenke syndrome: A cephalometric analysis and review of the literature.
Journal of Plastic Reconstructive and Aesthetic Surgery, 2016Co-Authors: Samra F, Scott P Bartlett, Andrew R. Bauder, Jordan W. Swanson, Linton A. Whitaker, Jesse A TaylorAbstract:Summary Background Max Muenke included Midface Hypoplasia as part of the clinical syndrome caused by the Pro250Arg FGFR3 mutation that now bears his name. Murine models have demonstrated Midface Hypoplasia in homozygous recessive mice only , with heterozygotes having normal Midfaces; as the majority of humans with the syndrome are heterozygotes, we investigated the incidence of Midface Hypoplasia in our institution's clinical cohort. Methods We retrospectively reviewed all patients with a genetic and clinical diagnosis of Muenke syndrome from 1990 to 2014. Review of clinical records and photographs included skeletal Angle Class, dental occlusion, and incidence of orthognathic intervention. Cephalometric evaluation of our patients was compared to the Eastman Standard Values. Results 18 patients met inclusion criteria – 7 females and 11 males, with average follow-up of 11.2 years (1.0–23.1). Cephalometric analysis revealed an average sella-nasion-A point angle (SNA) of 82.5 (67.8–88.8) and an average sella-nasion-B point angle (SNB) of 77.9 (59.6–84.1). The SNA of our cohort was found to be significantly different from the Eastman Standards (p = 0.017); subgroup analysis revealed that this was due to the mixed dentition group which had a higher than average SNA. 12 patients were noted to be in Class I occlusion, 4 in Class II malocclusion, and 2 in Class III malocclusion. Only one patient (6%) underwent orthognathic surgery for Class III malocclusion. Conclusions While a part of the original description of Muenke syndrome, clinically significant Midface Hypoplasia is not a common feature. This data is important, as it allows more accurate counseling of patients and families. Level of Evidence: III
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earlier evidence of spheno occipital synchondrosis fusion correlates with severity of Midface Hypoplasia in patients with syndromic craniosynostosis
Plastic and Reconstructive Surgery, 2014Co-Authors: Jesse A Goldstein, Scott P Bartlett, Thomas J Paliga, Jason D Wink, Jesse A TaylorAbstract:BACKGROUND: The spheno-occipital synchondrosis is an important driver of facial and cranial base growth. The current study characterizes its fusion in patients with Apert, Crouzon, and Pfeiffer syndromes and correlates early fusion with the presence, and degree, of Midface Hypoplasia. METHODS: A retrospective case-control study was performed of all syndromic patients treated between 1996 and 2012. Case computed tomographic scans and age- and sex-matched control scans were analyzed as demonstrating either open, partially fused, or completely fused synchondroses, and patient age at each scan was recorded. Midface Hypoplasia as determined by sella-nasion-A point angle measurement at the time of Midface surgery was correlated to fusion status. RESULTS: Fifty-four patients with 206 computed tomographic scans met inclusion criteria. Two hundred six age- and sex-matched control scans were also identified. Average age at computed tomographic scanning was 6.1 years. The earliest ages of partial and complete fusion were 1.1 and 7.0 years, respectively, among cases; and 6.2 and 12.7 years, respectively, among controls. The odds of synchondrosis fusion in case computed tomographic scans was 66.0 times that of controls (95 percent CI, 9.2 to 475.5 times that of controls; p < 0.000001). Average age of synchondrosis fusion was 3.5 years (range, 0.5 to 6.0 years). Average sella-nasion-A point angle at the time of Midface surgery was 67.5 degrees (range, 58 to 76 degrees), with a positive correlation between earlier age of fusion and more severe Midface Hypoplasia (p = 0.028). CONCLUSIONS: The spheno-occipital synchondrosis fuses earlier in syndromic patients compared with age-matched controls. Moreover, there is a positive correlation between earlier fusion and degree of Midface Hypoplasia, although definitive causality cannot be concluded. This is the first study to demonstrate such a correlation in human subjects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
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the spheno occipital synchondrosis fuses prematurely in patients with crouzon syndrome and Midface Hypoplasia compared with age and gender matched controls
Journal of Oral and Maxillofacial Surgery, 2014Co-Authors: Youssef Tahiri, Arastoo Vossough, Scott P Bartlett, Thomas J Paliga, Jesse A TaylorAbstract:Purpose Premature closure of the spheno-occipital synchondrosis (SOS) has been associated with Midface Hypoplasia in animal models and patients with specific forms of syndromic craniosynostosis. The present study aimed to characterize SOS fusion in patients with Crouzon syndrome. Patients and Methods A case-control study was performed in patients with Crouzon syndrome treated at the Children's Hospital of Philadelphia from 1984 to 2012. The cases included patients with Crouzon syndrome and at least 1 high-quality computed tomography (CT) scan in which SOS patency could be assessed. Age- and gender-matched control CT scans were identified for comparison. The patient age at the CT scan was evaluated as the predictor, with SOS patency identified as the outcome variable. Three independent reviewers with high inter-rater reliability graded the SOS patency as open, partially fused, or completely fused. The Wilcoxon rank sum test was used to compare the Crouzon group and the controls. Results During the study period, 30 patients were identified with Crouzon syndrome. A total of 24 patients, all with Midface Hypoplasia and with 112 cranial CT scans, met the inclusion criteria. Accordingly, 112 age- and gender-matched control CT scans were assessed. No patient in the control group had Midface Hypoplasia. Within the Crouzon group, the average age at complete closure (14.0 ± 3.4 years) evident on the CT scan was significantly younger than that in the control group (16.6 ± 2.2 years; P = .0152). The average age when the scans showed complete patency of the SOS in the Crouzon group (1.3 ± 1.1 years) was significantly younger than that in the control group (3.2 ± 2.3 years; P = .0001). Conclusions The SOS closes significantly earlier in patients with Crouzon syndrome compared with age- and gender-matched controls. The strong statistical correlation supports premature closure of the SOS as a possible mechanistic contributor to Midface Hypoplasia.
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premature closure of the spheno occipital synchondrosis in pfeiffer syndrome a link to Midface Hypoplasia
Journal of Craniofacial Surgery, 2014Co-Authors: James Thomas Paliga, Jesse A Goldstein, Arastoo Vossough, Scott P Bartlett, Jesse A TaylorAbstract:: The spheno-occipital synchondrosis (SOS) is a critical component of midfacial and cranial base growth. Premature closure has been associated with Midface Hypoplasia in animal models and syndromic craniosynostosis subpopulations with Apert and Muenke syndromes. To link premature SOS closure and Midface Hypoplasia in patients with Pfeiffer syndrome, a retrospective case-control study was performed in patients treated at a large craniofacial center between 1982 and 2012 diagnosed with Pfeiffer syndrome. At least 1 computed tomography (CT) scan was required to assess SOS patency. Age-/sex-matched control CT scans were also assessed for SOS patency. Three independent reviewers with high interrater reliability (κ = 0.88) graded SOS patency as open, partially closed, or completely closed. Wilcoxon rank sum test compared the Pfeiffer patients with control subjects. A total of 63 CT scans in 16 patients with Pfeiffer syndrome, all with Midface Hypoplasia, and 63 age-/sex-matched control scans, none of whom had Midface Hypoplasia, met inclusion criteria. Earliest partial SOS closure in patients with Pfeiffer syndrome was seen at 5 days compared with control subjects at 7.07 years. Earliest age at complete fusion was 2.76 years in the Pfeiffer cohort and 12.74 years in control subjects. Average age at partial closure was significantly younger (4.99 ± 3.33 years; n = 31 scans) in patients with Pfeiffer syndrome compared with control subjects (10.92 ± 3.53 years) (P = 0.0005), whereas average age at complete closure (11.90 ± 7.04 years) was not significantly different than that in control subjects (16.07 ± 3.39 years). Although definitive causality cannot be concluded, a strong correlation exists between Midface Hypoplasia and premature SOS closure in Pfeiffer syndrome.
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Differential closure of the spheno-occipital synchondrosis in syndromic craniosynostosis.
Plastic and Reconstructive Surgery, 2012Co-Authors: Jennifer L. Mcgrath, Derek M Steinbacher, Arastoo Vossough, Scott P Bartlett, Patrick A. Gerety, Christopher A. Derderian, Jesse A TaylorAbstract:Background:The spheno-occipital synchondrosis is a driver of cranial base and facial growth. Its premature fusion has been associated with Midface Hypoplasia in animal models. The authors reviewed computed tomographic scans of patients with Apert and Muenke syndrome, craniosynostosis syndromes with
Jonathan A. Perkins - One of the best experts on this subject based on the ideXlab platform.
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Quantitative computed tomographic scan and polysomnographic analysis of patients with syndromic Midface Hypoplasia before and after Le Fort III distraction advancement.
Plastic and Reconstructive Surgery, 2011Co-Authors: Russell E. Ettinger, Richard A Hopper, Gavin Sandercoe, Yemiserach Kifle, Babette S. Saltzman, Maida Chen, Jonathan A. PerkinsAbstract:BACKGROUND: Distraction advancement has been advocated for treatment of obstructive sleep apnea associated with congenital Midface Hypoplasia. The purpose of this study was to relate changes in maxillary position to changes in obstructive sleep apnea measures on polysomnography in a consecutive series of patients. METHODS: Among 26 syndromic pediatric patients undergoing Le Fort III distraction over a 5-year period, 15 had documented obstructive sleep apnea with an apnea hypopnea index greater than 5. Linear and angular displacement of key bone landmarks were measured using quantitative computed tomographic scan analysis before and after distraction. Differences of linear and angular movements of maxillary landmarks were tested between those patients with improvement of obstructive sleep apnea (apnea hypopnea index
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quantitative computed tomographic scan and polysomnographic analysis of patients with syndromic Midface Hypoplasia before and after le fort iii distraction advancement
Plastic and Reconstructive Surgery, 2011Co-Authors: Russell E. Ettinger, Richard A Hopper, Gavin Sandercoe, Yemiserach Kifle, Babette S. Saltzman, Maida Chen, Jonathan A. PerkinsAbstract:BACKGROUND: Distraction advancement has been advocated for treatment of obstructive sleep apnea associated with congenital Midface Hypoplasia. The purpose of this study was to relate changes in maxillary position to changes in obstructive sleep apnea measures on polysomnography in a consecutive series of patients. METHODS: Among 26 syndromic pediatric patients undergoing Le Fort III distraction over a 5-year period, 15 had documented obstructive sleep apnea with an apnea hypopnea index greater than 5. Linear and angular displacement of key bone landmarks were measured using quantitative computed tomographic scan analysis before and after distraction. Differences of linear and angular movements of maxillary landmarks were tested between those patients with improvement of obstructive sleep apnea (apnea hypopnea index <5) after treatment, and those with no improvement. RESULTS: Mean postoperative apnea hypopnea index was 9.5 (range, 2.1 to 22.7). Eight patients had a decrease in apnea hypopnea index following distraction (improved group) and three additional patients had resolution of symptoms but declined postoperation polysomnography. Four had no improvement or worsening of apnea hypopnea index (no improvement group). Comparison of changes in maxillary position between the improved group and the no improvement group revealed no significant difference in magnitude or direction of linear displacement of key landmarks. Postdistraction change in sella-nasion-point A angle was the only measure significantly (p = 0.02) greater in the improved group. CONCLUSIONS: Based on the authors' comparison of quantitative bone measurements and associated polysomnography changes, an angular increase in sella-nasion-point A angle on presurgical planning of maxillary movement for the treatment of sleep apnea may be more important than absolute linear changes in maxillary position alone.
Scott P Bartlett - One of the best experts on this subject based on the ideXlab platform.
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Assessing the Midface in Muenke syndrome: A cephalometric analysis and review of the literature.
Journal of Plastic Reconstructive and Aesthetic Surgery, 2016Co-Authors: Samra F, Scott P Bartlett, Andrew R. Bauder, Jordan W. Swanson, Linton A. Whitaker, Jesse A TaylorAbstract:Summary Background Max Muenke included Midface Hypoplasia as part of the clinical syndrome caused by the Pro250Arg FGFR3 mutation that now bears his name. Murine models have demonstrated Midface Hypoplasia in homozygous recessive mice only , with heterozygotes having normal Midfaces; as the majority of humans with the syndrome are heterozygotes, we investigated the incidence of Midface Hypoplasia in our institution's clinical cohort. Methods We retrospectively reviewed all patients with a genetic and clinical diagnosis of Muenke syndrome from 1990 to 2014. Review of clinical records and photographs included skeletal Angle Class, dental occlusion, and incidence of orthognathic intervention. Cephalometric evaluation of our patients was compared to the Eastman Standard Values. Results 18 patients met inclusion criteria – 7 females and 11 males, with average follow-up of 11.2 years (1.0–23.1). Cephalometric analysis revealed an average sella-nasion-A point angle (SNA) of 82.5 (67.8–88.8) and an average sella-nasion-B point angle (SNB) of 77.9 (59.6–84.1). The SNA of our cohort was found to be significantly different from the Eastman Standards (p = 0.017); subgroup analysis revealed that this was due to the mixed dentition group which had a higher than average SNA. 12 patients were noted to be in Class I occlusion, 4 in Class II malocclusion, and 2 in Class III malocclusion. Only one patient (6%) underwent orthognathic surgery for Class III malocclusion. Conclusions While a part of the original description of Muenke syndrome, clinically significant Midface Hypoplasia is not a common feature. This data is important, as it allows more accurate counseling of patients and families. Level of Evidence: III
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earlier evidence of spheno occipital synchondrosis fusion correlates with severity of Midface Hypoplasia in patients with syndromic craniosynostosis
Plastic and Reconstructive Surgery, 2014Co-Authors: Jesse A Goldstein, Scott P Bartlett, Thomas J Paliga, Jason D Wink, Jesse A TaylorAbstract:BACKGROUND: The spheno-occipital synchondrosis is an important driver of facial and cranial base growth. The current study characterizes its fusion in patients with Apert, Crouzon, and Pfeiffer syndromes and correlates early fusion with the presence, and degree, of Midface Hypoplasia. METHODS: A retrospective case-control study was performed of all syndromic patients treated between 1996 and 2012. Case computed tomographic scans and age- and sex-matched control scans were analyzed as demonstrating either open, partially fused, or completely fused synchondroses, and patient age at each scan was recorded. Midface Hypoplasia as determined by sella-nasion-A point angle measurement at the time of Midface surgery was correlated to fusion status. RESULTS: Fifty-four patients with 206 computed tomographic scans met inclusion criteria. Two hundred six age- and sex-matched control scans were also identified. Average age at computed tomographic scanning was 6.1 years. The earliest ages of partial and complete fusion were 1.1 and 7.0 years, respectively, among cases; and 6.2 and 12.7 years, respectively, among controls. The odds of synchondrosis fusion in case computed tomographic scans was 66.0 times that of controls (95 percent CI, 9.2 to 475.5 times that of controls; p < 0.000001). Average age of synchondrosis fusion was 3.5 years (range, 0.5 to 6.0 years). Average sella-nasion-A point angle at the time of Midface surgery was 67.5 degrees (range, 58 to 76 degrees), with a positive correlation between earlier age of fusion and more severe Midface Hypoplasia (p = 0.028). CONCLUSIONS: The spheno-occipital synchondrosis fuses earlier in syndromic patients compared with age-matched controls. Moreover, there is a positive correlation between earlier fusion and degree of Midface Hypoplasia, although definitive causality cannot be concluded. This is the first study to demonstrate such a correlation in human subjects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
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the spheno occipital synchondrosis fuses prematurely in patients with crouzon syndrome and Midface Hypoplasia compared with age and gender matched controls
Journal of Oral and Maxillofacial Surgery, 2014Co-Authors: Youssef Tahiri, Arastoo Vossough, Scott P Bartlett, Thomas J Paliga, Jesse A TaylorAbstract:Purpose Premature closure of the spheno-occipital synchondrosis (SOS) has been associated with Midface Hypoplasia in animal models and patients with specific forms of syndromic craniosynostosis. The present study aimed to characterize SOS fusion in patients with Crouzon syndrome. Patients and Methods A case-control study was performed in patients with Crouzon syndrome treated at the Children's Hospital of Philadelphia from 1984 to 2012. The cases included patients with Crouzon syndrome and at least 1 high-quality computed tomography (CT) scan in which SOS patency could be assessed. Age- and gender-matched control CT scans were identified for comparison. The patient age at the CT scan was evaluated as the predictor, with SOS patency identified as the outcome variable. Three independent reviewers with high inter-rater reliability graded the SOS patency as open, partially fused, or completely fused. The Wilcoxon rank sum test was used to compare the Crouzon group and the controls. Results During the study period, 30 patients were identified with Crouzon syndrome. A total of 24 patients, all with Midface Hypoplasia and with 112 cranial CT scans, met the inclusion criteria. Accordingly, 112 age- and gender-matched control CT scans were assessed. No patient in the control group had Midface Hypoplasia. Within the Crouzon group, the average age at complete closure (14.0 ± 3.4 years) evident on the CT scan was significantly younger than that in the control group (16.6 ± 2.2 years; P = .0152). The average age when the scans showed complete patency of the SOS in the Crouzon group (1.3 ± 1.1 years) was significantly younger than that in the control group (3.2 ± 2.3 years; P = .0001). Conclusions The SOS closes significantly earlier in patients with Crouzon syndrome compared with age- and gender-matched controls. The strong statistical correlation supports premature closure of the SOS as a possible mechanistic contributor to Midface Hypoplasia.
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premature closure of the spheno occipital synchondrosis in pfeiffer syndrome a link to Midface Hypoplasia
Journal of Craniofacial Surgery, 2014Co-Authors: James Thomas Paliga, Jesse A Goldstein, Arastoo Vossough, Scott P Bartlett, Jesse A TaylorAbstract:: The spheno-occipital synchondrosis (SOS) is a critical component of midfacial and cranial base growth. Premature closure has been associated with Midface Hypoplasia in animal models and syndromic craniosynostosis subpopulations with Apert and Muenke syndromes. To link premature SOS closure and Midface Hypoplasia in patients with Pfeiffer syndrome, a retrospective case-control study was performed in patients treated at a large craniofacial center between 1982 and 2012 diagnosed with Pfeiffer syndrome. At least 1 computed tomography (CT) scan was required to assess SOS patency. Age-/sex-matched control CT scans were also assessed for SOS patency. Three independent reviewers with high interrater reliability (κ = 0.88) graded SOS patency as open, partially closed, or completely closed. Wilcoxon rank sum test compared the Pfeiffer patients with control subjects. A total of 63 CT scans in 16 patients with Pfeiffer syndrome, all with Midface Hypoplasia, and 63 age-/sex-matched control scans, none of whom had Midface Hypoplasia, met inclusion criteria. Earliest partial SOS closure in patients with Pfeiffer syndrome was seen at 5 days compared with control subjects at 7.07 years. Earliest age at complete fusion was 2.76 years in the Pfeiffer cohort and 12.74 years in control subjects. Average age at partial closure was significantly younger (4.99 ± 3.33 years; n = 31 scans) in patients with Pfeiffer syndrome compared with control subjects (10.92 ± 3.53 years) (P = 0.0005), whereas average age at complete closure (11.90 ± 7.04 years) was not significantly different than that in control subjects (16.07 ± 3.39 years). Although definitive causality cannot be concluded, a strong correlation exists between Midface Hypoplasia and premature SOS closure in Pfeiffer syndrome.
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Analysis of the long-term growth of the mandible in Apert syndrome.
Journal of Craniofacial Surgery, 2013Co-Authors: Jason D Wink, Nicholas Bastidas, Scott P BartlettAbstract:AbstractApert syndrome carries a characteristic phenotype of Midface Hypoplasia, syndactyly, craniosynostosis, and developmental delay. These patients frequently require a large number of surgical procedures to produce a functional and aesthetically pleasing correction of their facial deformities. A
Irene M J Mathijssen - One of the best experts on this subject based on the ideXlab platform.
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the effect of early fusion of the spheno occipital synchondrosis on Midface Hypoplasia and obstructive sleep apnea in patients with crouzon syndrome
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Caroline Driessen, Bianca F M Rijken, Priya N Doerga, Marjolein H G Dremmen, Koen F M Joosten, Irene M J MathijssenAbstract:Abstract Introduction The investigators hypothesized that patients with Crouzon syndrome and premature fusion of the spheno-occipital synchondrosis (SOS) more often have, or have more severe Midface Hypoplasia and obstructive sleep apnea (OSA). Methods A prospective cohort study was performed among patients with Crouzon syndrome to analyze SOS closure, Midface Hypoplasia represented by the sella-nasion angle (SNA) and OSA. Results Forty patients were included in whom the OSA-prevalence was 65%. Kaplan Meier analyses suggest a trend towards earlier closure of synchondrosis in patients with OSA (p = 0.066). The mean SNA was 74.7°. There was a positive effect of age on the SNA (p = 0.020). There was no difference in SNA for patients with an open SOS as compared to patients with a closed SOS after correction for age. Conclusions The longitudinal data are suggestive of a trend towards earlier fusion of the SOS in patients with Crouzon syndrome and OSA as compared to patients with Crouzon syndrome without OSA. Although the SNA increases with age, our results suggest that this increase in independent closure of the SOS.
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How does obstructive sleep apnoea evolve in syndromic craniosynostosis? A prospective cohort study
Archives of Disease in Childhood, 2013Co-Authors: Caroline Driessen, Koen F M Joosten, Eppo B. Wolvius, Natalja Bannink, Hansje H. Bredero-boelhouwer, Hans L.j. Hoeve, Dimitris Rizopoulos, Irene M J MathijssenAbstract:Objective To describe the course of obstructive sleep apnoea syndrome (OSAS) in children with syndromic craniosynostosis. Design Prospective cohort study. Setting Dutch Craniofacial Centre from January 2007 to January 2012. Patients A total of 97 children with syndromic craniosynostosis underwent level III sleep study. Patients generally undergo cranial vault remodelling during their first year of life, but OSAS treatment only on indication. Main outcome measures Obstructive apnoea-hypopnoea index, the central apnoea index and haemoglobin oxygenation-desaturation index derived from consecutive sleep studies. Results The overall prevalence of OSAS in syndromic craniosynostosis was 68% as defined by level III sleep study. Twenty-three patients were treated for OSAS. Longitudinal profiles were computed for 80 untreated patients using 241 sleep studies. A mixed effects model showed higher values for the patients with Midface Hypoplasia as compared to those without Midface Hypoplasia (Omnibus likelihood ratio test=7.9). In paired measurements, the obstructive apnoea-hypopnoea index (Z=−3.4) significantly decreased over time, especially in the first years of life (Z=−3.3), but not in patients with Midface Hypoplasia (Z=−1.5). No patient developed severe OSAS during follow-up if it was not yet diagnosed during the first sleep study. Conclusions OSAS is highly prevalent in syndromic craniosynostosis. There is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome. In the absence of other co-morbid risk factors, it is highly unlikely that if severe OSAS is not present early in life it will develop during childhood. Ongoing clinical surveillance is of great importance and continuous monitoring for the development of other co-morbid risk factors for OSAS should be warranted.
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Use of ambulatory polysomnography in children with syndromic craniosynostosis
Journal of Craniofacial Surgery, 2010Co-Authors: Natalja Bannink, Irene M J Mathijssen, Koen F M JoostenAbstract:AbstractChildren with syndromic or complex craniosynostosis are at risk of developing obstructive sleep apnea (OSA) because of Midface Hypoplasia and collapse of the pharynx. The criterion standard in diagnosing OSA is polysomnography. The aims of this study were to analyze the feasibility of a home
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Internal carotid dissection after Le Fort III distraction in Apert syndrome: A case report
Journal of Cranio-maxillofacial Surgery, 2010Co-Authors: Erik Nout, Irene M J Mathijssen, Maarten H. Lequin, Jacques J.n.m. Van Der Meulen, Marie-lise C. Van Veelen, Anton H.j. Koning, Eppo B. WolviusAbstract:A 10-year-old girl with Apert syndrome underwent a Le Fort III osteotomy with the positioning of internal and external distraction devices. The operation was straightforward with no intraoperative complications. Very soon after completion of surgery an anisocoria (unilateral dilation of a pupil) was noticed. This was followed by intracranial oedema which was fatal. The aetiology was dissection of the right internal carotid artery is reported. The complications of Le Fort osteotomies are discussed regarding patients with complex syndromal craniosynostosis and Midface Hypoplasia, such as Apert syndrome.
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Advancement of the Midface, from conventional Le Fort III osteotomy to Le Fort III distraction: review of the literature
International Journal of Oral and Maxillofacial Surgery, 2008Co-Authors: Erik Nout, Irene M J Mathijssen, L.l.m. Cesteleyn, L.n.a. Van Adrichem, Eppo B. WolviusAbstract:Since its introduction in about 1950, the Le Fort III (LF III) procedure has become a widely accepted treatment for correction of Midface Hypoplasia and related functional and esthetic problems. As long-term surgical experience grows and improvements are made in technique, equipment and peri-operative care, the number of LF III procedures performed worldwide is increasing. A number of fundamental questions concerning the technique remain unclear, and large, conclusive studies are lacking owing to the relative rarity of severe Midface Hypoplasia. This literature review aims to address problems, such as the indication field, timing of surgery, rate of relapse and the use of distraction osteogenesis. An overview of the history and technique of LF III osteotomy and distraction is provided, together with a comprehensive review of the available clinical data.
Russell E. Ettinger - One of the best experts on this subject based on the ideXlab platform.
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Quantitative computed tomographic scan and polysomnographic analysis of patients with syndromic Midface Hypoplasia before and after Le Fort III distraction advancement.
Plastic and Reconstructive Surgery, 2011Co-Authors: Russell E. Ettinger, Richard A Hopper, Gavin Sandercoe, Yemiserach Kifle, Babette S. Saltzman, Maida Chen, Jonathan A. PerkinsAbstract:BACKGROUND: Distraction advancement has been advocated for treatment of obstructive sleep apnea associated with congenital Midface Hypoplasia. The purpose of this study was to relate changes in maxillary position to changes in obstructive sleep apnea measures on polysomnography in a consecutive series of patients. METHODS: Among 26 syndromic pediatric patients undergoing Le Fort III distraction over a 5-year period, 15 had documented obstructive sleep apnea with an apnea hypopnea index greater than 5. Linear and angular displacement of key bone landmarks were measured using quantitative computed tomographic scan analysis before and after distraction. Differences of linear and angular movements of maxillary landmarks were tested between those patients with improvement of obstructive sleep apnea (apnea hypopnea index
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quantitative computed tomographic scan and polysomnographic analysis of patients with syndromic Midface Hypoplasia before and after le fort iii distraction advancement
Plastic and Reconstructive Surgery, 2011Co-Authors: Russell E. Ettinger, Richard A Hopper, Gavin Sandercoe, Yemiserach Kifle, Babette S. Saltzman, Maida Chen, Jonathan A. PerkinsAbstract:BACKGROUND: Distraction advancement has been advocated for treatment of obstructive sleep apnea associated with congenital Midface Hypoplasia. The purpose of this study was to relate changes in maxillary position to changes in obstructive sleep apnea measures on polysomnography in a consecutive series of patients. METHODS: Among 26 syndromic pediatric patients undergoing Le Fort III distraction over a 5-year period, 15 had documented obstructive sleep apnea with an apnea hypopnea index greater than 5. Linear and angular displacement of key bone landmarks were measured using quantitative computed tomographic scan analysis before and after distraction. Differences of linear and angular movements of maxillary landmarks were tested between those patients with improvement of obstructive sleep apnea (apnea hypopnea index <5) after treatment, and those with no improvement. RESULTS: Mean postoperative apnea hypopnea index was 9.5 (range, 2.1 to 22.7). Eight patients had a decrease in apnea hypopnea index following distraction (improved group) and three additional patients had resolution of symptoms but declined postoperation polysomnography. Four had no improvement or worsening of apnea hypopnea index (no improvement group). Comparison of changes in maxillary position between the improved group and the no improvement group revealed no significant difference in magnitude or direction of linear displacement of key landmarks. Postdistraction change in sella-nasion-point A angle was the only measure significantly (p = 0.02) greater in the improved group. CONCLUSIONS: Based on the authors' comparison of quantitative bone measurements and associated polysomnography changes, an angular increase in sella-nasion-point A angle on presurgical planning of maxillary movement for the treatment of sleep apnea may be more important than absolute linear changes in maxillary position alone.