Facial Bones

We reviewed 45 patients with a deletion of the long arm of chromosome 4. Forty-one were previous reports (25 terminal deletions and 16 interstitial deletions) and 4 are new cases with terminal deletions. Of the 29 patients with terminal deletions, 18 with deletion at 4q31 and 4 at 4q32 qter had an identifiable phenotype consisting of abnormal skull shape, hypertelorism, cleft palate, apparently low-set abnormal pinnae, short nose with abnormal bridge, virtually pathognomonic pointed fifth finger and nail, congenital heart and genitourinary defects, moderate-severe mental retardation, poor postnatal growth, and hypotonia. Six patients with a deletion at 4q33 and one patient with deletion 4q34 were less severely affected. In general, patients with various interstitial deletions proximal to 4q31 had a phenotype that was less specific, although mental retardation and minor craniofacial anomalies were also present. There were 3 patients with piebaldism and one with Rieger syndrome. We conclude that terminal deletion of chromosome 4q (4q31 qter) appears to produce a distinctive malformation (MCA/MR) syndrome in which the phenotype correlates with the amount of chromosome material missing and which differs from the more variable phenotype associated with interstitial deletions of 4q.

In a 4-year period, 40 compact aluminum oxide ceramic implants fixed with titanium plates and screws were used: 24 for the correction of mandibular defects, 9 for temporomandibular joint replacement, and 7 for augmentation of facial contour. During the 1 to 4 years following the operations, it was not necessary to remove any aluminum oxide joint or implant used for contour correction. In 5 of the 24 cases of mandibular reconstruction, however, it was necessary to remove the ceramic. In 3 cases, this was due to recurrence of the tumor, and in 2 cases the cause was dermal necrosis.

A three-dimensional, multiplane cephalometric analysis is presented. This analysis permits visualization of skeletal midlines at selected depths of the craniofacial complex. When the midlines and associated anatomic structures are studied sequentially, the individual midlines may be combined conceptually into a warped midsagittal "plane." This localizes craniofacial asymmetry in the posteroanterior and basilar views. The study of structures in various coronal and transverse planes makes it possible to measure and record the three-dimensional relationships of anatomic structures to one another. A case of hemicraniofacial microsomia in which this analysis was used is presented.

By definition, degloving is skin and subcutaneous tissue detachment, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally stems from high-energy trauma, but can also be intentional, such as in the case of planned surgical access in the anterior region of the mandible in oral-maxillofacial surgery. This paper describes an extreme case of complete traumatic maxillofacial degloving that caused partial avulsion of the soft tissues and maxilla. This is an extremely rare condition that has not previously been described in the literature, as the patient survived despite the risk of imminent death. This case report addresses the decisions made regarding the prevention of necrosis and infection that guided the emergency care and subsequent elective steps.

Approximately 22 million children in the United States sustain traumatic injuries every year, the etiologies of which vary with age as well as social and environmental factors. If not managed properly, these injuries can have a significant impact on future growth and development. Evaluation of facial injuries presents a unique diagnostic challenge in this population, as differences from adult anatomy and physiology can result in vastly different injury profiles. The increased ratio of the cranial mass relative to the body leaves younger patients more vulnerable to craniofacial trauma. It is essential that the treating physician be aware of these variations to properly assess and treat this susceptible and fragile patient population and ensure optimal outcomes. This article reviews the proper emergency department assessment and treatment of facial fractures in the pediatric population as well as any associated injuries, with particular emphasis on initial patient stabilization, radio...

This article presents a method of cephalometric tracing and analysis using the basilar view cephalogram and discusses its role in diagnosis and treatment planning. Landmarks and structures found in each of three separate basilar planes are defined and instructions for tracings are presented. The analysis is applied to the study of orbital hypertelorism, craniofacial synostosis, and hemicraniofacial microsomia. The multiplane tracing technique is demonstrated to provide a three-dimensional concept of deformities in the craniofacial skeleton. A method to determine an anteroposterior midline construct from structures in the cranial base is described. As is practiced with the lateral cephalogram, presurgical tracings of the basilar film may be manipulated to simulate the skeletal changes anticipated in surgery.

CT imaging of complex maxillofacial fractures is common practice now, but the relative diagnostic value of spiral computed tomography (CT), multiplanar reformations (MPR), and three-dimensional (3D) reconstructions in evaluating maxillofacial fractures is not established with ...

Abstract:  With the ever increasing production of average soft tissue depth studies, data are becoming increasingly complex, less standardized, and more unwieldy. So far, no overarching review has been attempted to determine: the validity of continued data collection; the usefulness of the existing data subcategorizations; or if a synthesis is possible to produce a manageable soft tissue depth library. While a principal components analysis would provide the best foundation for such an assessment, this type of investigation is not currently possible because of a lack of easily accessible raw data (first, many studies are narrow; second, raw data are infrequently published and/or stored and are not always shared by some authors). This paper provides an alternate means of investigation using an hierarchical approach to review and compare the effects of single variables on published mean values for adults whilst acknowledging measurement errors and within-group variation. The results revealed: (i) no clear secular trends at frequently investigated landmarks; (ii) wide variation in soft tissue depth measures between different measurement techniques irrespective of whether living persons or cadavers were considered; (iii) no clear clustering of non-Caucasoid data far from the Caucasoid means; and (iv) minor differences between males and females. Consequently, the data were pooled across studies using weighted means and standard deviations to cancel out random and opposing study-specific errors, and to produce a single soft tissue depth table with increased sample sizes (e.g., 6786 individuals at pogonion).