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Objective@#To investigate the clinical characteristics and outcomes of pediatric Langerhans cell histiocytosis (LCH) with craniofacial bone involvement.@*Methods@#A retrospective analysis was performed on 145 pediatric LCH patients with craniofacial bone involvement registered at Beijing Children′s Hospital Affiliated to Capital Medical University from January 2007 to July 2013.The patients were divided into 2 groups: central nervous system risk craniofacial bone involvement group(CNS-RISK) and non-central nervous system risk craniofacial bone involvement group(non-CNS-RISK). All patients were assessed at 5 weeks, 11 weeks, 25 weeks and 52 weeks respectively after chemotherapy started, and 3 months, 6 months, 1 year and 3 years after chemotherapy withdrawal.Statistics and related risk analysis was performed respectively.@*Results@#A total of 145 craniofacial bone involved LCH cases were included, which was composed of 62.5% of 232 LCH cases hospitalized during the same period.The median age of these patients was 29 months, and median follow-up time period was 31 months.The most commonly involved craniofacial bone was parietal bone(78 cases, 53.8%), followed by temporal bone(59 cases, 40.7%) and frontal bone(57 cases, 39.3%). The onset age was significantly different (26 months vs.54 months, Z=-2.777, P<0.05) between CNS-RISK group (103 cases) and non-CNS-RISK group (42 cases). Moreover, compared with non-CNS-RISK group, CNS-RISK group showed higher ratio of patients classified as multisystem involvement of risk organs (72/103 cases, 69.9%)vs.(15/42 cases, 35.7%)(χ2=16.908, P<0.05), and a higher rate of overall relapse rate (45/103 cases, 43.7%) vs. (7/42 cases, 16.7%) (χ2=9.427, P<0.05), a lower survival rate of 3-year relapse-free survival rate [(66.9±5.7)% vs.(88.2±7.8)%, Z=2.205, P<0.05]. The incidence of diabetes insipidus was 13.7% in 232 LCH patients.Compared with patients without craniofacial bone involvement, patients with craniofacial bone involvement demonstrated a higher rate of diabetes insipidus [(27/145 cases, 18.6%) vs.(5/87 cases, 5.7%), χ2=7.579, P=0.006]. But the incidence of diabetes insipidus showed no statistical difference between CNS-RISK group and non-CNS-RISK group (21.3% and 11.9%, χ2=1.760, P=0.185). Diabetes insipidus was not found in single system LCH with Single-Bone CNS-RISK lesions.Till the end of follow-up, 1 out of 145 patients died.Among 145 patients, 5 cases had a single-bone CNS-RISK lesion.They received systemic chemotherapy.One showed reactivation, and none of them died.Multivariate analysis of variance showed that all the independent factors indicating diabetes insipidus included parietal bone, frontal bone, maxilla and mandible involvement(HR=2.697, 3.487, 5.425, all P<0.05), while independent factors indicating relapse included temporal bone, maxilla and mandible involvement(HR=3.712, 3.380, all P<0.05).@*Conclusions@#Among involved craniofacial bones, the parietal bone is most commonly involved.LCH occurs averagely at an earlier age in CNS-RISK group, along with lower 3-year relapse-free survival rate, high relapse rate, and more patients classified as multisystem LCH involvement of risk organs.The incidence of diabetes insipidus in children with craniofacial bone involvement with single system CNS-RISK is low.Patients with the parietal bone, frontal bone, maxilla and mandible involvement at diagnosis are at a increasing risk a significantly to develop DI during the course of disease.
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Objective To investigate the clinical characteristics and outcomes of pediatric Langerhans cell histiocytosis (LCH) with craniofacial bone involvement.Methods A retrospective analysis was performed on 145 pediatric LCH patients with craniofacial bone involvement registered at Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to July 2013.The patients were divided into 2 groups:central nervous system risk craniofacial bone involvement group(CNS-RISK) and non-central nervous system risk craniofacial bone involvement group(non-CNS-RISK).All patients were assessed at 5 weeks,11 weeks,25 weeks and 52 weeks respectively after chemotherapy started,and 3 months,6 months,1 year and 3 years after chemotherapy withdrawal.Statistics and related risk analysis was performed respectively.Results A total of 145 craniofacial bone involved LCH cases were included,which was composed of 62.5％ of 232 LCH cases hospitalized during the same period.The median age of these patients was 29 months,and median follow-up time period was 31 months.The most commonly involved craniofacial bone was parietal bone(78 cases,53.8％),followed by temporal bone(59 cases,40.7％) and frontal bone(57 cases,39.3％).The onset age was significantly different (26 months vs.54 months,Z =-2.777,P ＜ 0.05) between CNS-RISK group (103 cases) and non-CNS-RISK group (42 cases).Moreover,compared with non-CNS-RISK group,CNS-RISK group showed higher ratio of patients classified as multisystem involvement of risk organs (72/103 cases,69.9％) vs.(15/42 cases,35.7％) (x2 =16.908,P ＜ 0.05),and a higher rate of overall relapse rate (45/103 cases,43.7％) vs.(7/42 cases,16.7％) (x2 =9.427,P ＜ 0.05),a lower survival rate of 3-year relapse-free survival rate [(66.9 ± 5.7) ％ vs.(88.2 ± 7.8) ％,Z =2.205,P ＜ 0.05].The incidence of diabetes insipidus was 13.7％ in 232 LCH patients.Compared with patients without craniofacial bone involvement,patients with craniofacial bone involvement demonstrated a higher rate of diabetes insipidus [(27/145 cases,18.6％) vs.(5/87 cases,5.7％),x2 =7.579,P =0.006].But the incidence of diabetes insipidus showed no statistical difference between CNS-RISK group and non-CNS-RISK group (21.3 ％ and 11.9 ％,x2 =1.760,P =0.185).Diabetes insipidus was not found in single system LCH with Single-Bone CNS-RISK lesions.Till the end of follow-up,1 out of 145 patients died.Among 145 patients,5 cases had a single-bone CNS-RISK lesion.They received systemic chemotherapy.One showed reactivation,and none of them died.Multivariate analysis of variance showed that all the independent factors indicating diabetes insipidus included parietal bone,frontal bone,maxilla and mandible involvement (HR =2.697,3.487,5.425,all P ＜ 0.05),while independent factors indicating relapse included temporal bone,maxilla and mandible involvement (HR =3.712,3.380,all P ＜ 0.05).Conclusions Among involved craniofacial bones,the parietal bone is most commonly involved.LCH occurs averagely at an earlier age in CNS-RISK group,along with lower 3-year relapse-free survival rate,high relapse rate,and more patients classified as multisystem LCH involvement of risk organs.The incidence of diabetes insipidus in children with craniofacial bone involvement with single system CNS-RISK is low.Patients with the parietal bone,frontal bone,maxilla and mandible involvement at diagnosis are at a increasing risk a significantly to develop DI during the course of disease.
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Objective@#To explore the correlation between the parameters of the mandible and parameters of cervical vertebrae and craniofacial bone in class Ⅱ skeletal patients in Northeast China and to establish correlation equations expressing the relationship between the mandible and cervical vertebrae and craniofacial bone directly and quantitatively for the clinical diagnosis and treatment of orthodontics and orthognathics and for prediction. @*Methods @#The mandible, cranial facial bone and cervical vertebrae of 201 children and adolescents aged 8 to 20 years were measured using digital cranial lateral tablets. All of the cases were divided into male (n=75) and female (n=126) groups using a sensitivity analysis method based on genetic algorithms to select the craniofacial bone and cervical bone with strong sensitivity to mandible parameters and to establish relevant equations. @*Results @#Through sensitivity analysis, the parameters with the strongest correlation between the measured values of the mandible were H4 and SN, those with a strong correlation were SN-Ar, the anterior and posterior high ratio SGo/NGn, the Y axis angle and mandibular angle Ar-Go-Gn. The established equation was as follows: males: Ar-Pg=28.415+1.818×H4+0.746×SN(r2=0.056 8, P < 0.001); females: Ar-Pg=15.168+1.706×H4+0.675×SN+0.31×SN-Ar-0.29×Y axis angle (r2=0.611, P < 0.001). No significant difference was found between the predicted values obtained by the established equations and measured values (P > 0.05). @*Conclusion @#The mandibular length equation established by sensitivity analysis and genetic algorithms is statistically significant and can predict a certain degree of growth and development.
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Objective To explore the imaging features and pathological characteristics of fibrous dysplasia of craniofacial bone. Methods 42 cases with fibrous dysplasia of craniofacial bone confirmed surgically and pathologically were retrospectively analyzed. Results There were 35 cases with single bone involved and 7 cases with poly-bone involved. On CT images, the lesions appeared as glass-like change(79.3%). The main pathological components of the lesion were fiber and fiber-like tissue, which were low signals on both T_1 WI and T_2 WI, and the signal intensity was changed with the accompanied by hemorrhage, necrosis or cystic degeneration. Conclusion CT and MRI are the effective imaging modality in diagnosis of fibrous dysplasia of craniofacial bone.
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Objective To explore the effects of Medpor in surgical treatment of craniofacial de-pressed deformities. Methods Combining with other surgical methods, 37 patients with craniofacial de-pressed deformities were treated with Medpor. Of them, 29 cases of craniofacial depression and defects subjected to trauma, 6 cases were progressive facial hemiatrophy and 2 case were angle of mandible de-formity. All were followed up from three months to four year. Results Facial configurations and func-tions of all the 37 cases were greatly improved after the treatment, without any complication of infection or rejection;patients were all very satisfactory or relatively satisfied with the results. Conclusion Med-por is an ideal implant material to correct the deformity of earaniofacial, and combining with others methods, the treatment of earaniofacial deformity can obtain good results.
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PURPOSE: Plate systems have been used for osteosynthesis of cranial and oromaxillofacial fracture. However, there is no consensus on the need for routine removal of plate and the question about indications of removal. Therefore, we present the retrospective study to clarify the indications and consensus of removal. METHODS: The medical records of patients who were treated with rigid internal fixation using plates after craniofacial trauma were reviewed. Study variables included age, gender, type of fracture, type of plate, seniority of the operator, causes of removal, and time between insertion and removal. All results amendable to statistics were analyzed using SPSS 10.0 to determine which set of variables might affect the fate of the plates. RESULTS: For a period of 10 years (March 1, 1994 through July 31, 2004), total of 41 plates(6.7%) were removed among 609 plates inserted into 419 patients; 27 plates were removed from 15 patients for infection, which is the most common cause of removal accounting for 65.8%. Mean time between insertion and removal is 35.2 months and mean age is 41.4 years. Most plates were removed from combined fracture(14.92%) and facial fracture(8.47%) and these were statistically significant. The age, gender, seniority of the operator and other variables were not statistically associated with plate removal. CONCLUSION: This retrospective study shows that routine removal does not appear to be clinically indicated due to respectively low removal rate and that the commonest indications for removal were infection.
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Humans , Consensus , Medical Records , Retrospective StudiesABSTRACT
PURPOSE: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load- bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. METHODS: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from 1.0 X 1.5 cm to 12 X 10 cm. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. RESULTS: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. CONCLUSION: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.
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Humans , Follow-Up Studies , Foreign-Body Reaction , Mandible , Maxilla , Nasal Bone , Orbit , Recurrence , Skull , Skull Base , Tissue Donors , Titanium , Weight-Bearing , Wound Infection , ZygomaABSTRACT
PURPOSE: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load- bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. METHODS: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from 1.0 X 1.5 cm to 12 X 10 cm. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. RESULTS: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. CONCLUSION: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.
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Humans , Follow-Up Studies , Foreign-Body Reaction , Mandible , Maxilla , Nasal Bone , Orbit , Recurrence , Skull , Skull Base , Tissue Donors , Titanium , Weight-Bearing , Wound Infection , ZygomaABSTRACT
Skull or facial bone defect causes cosmetic and functional problems. On going efforts were taken to reconstruct the craniofacial bone defect with autogenous bone or alloplastic materials. Between 2001 and 2003, we reconstructed 15 cases with small to large craniofacial bone defect using Hydroxyapatite paste(Bonesource(R), Leibinger Corp., Dallas, TX, U.S.A) and calvarial bone graft. All patients were followed up by clinical examination and periodic radiographic studies for an average of 1.6 years (range, 6 months to 2 years and 6 months). One complication case was noted with Bonesource(R) exposure. Otherwise, there was no evidence of adverse healing, wound infection, foreign body reaction and seroma collection in other patients. Adequate 3-dimensional aesthetic restoration of calvarial contour was noted in each case. In conclusion, Bonesource(R) is relatively safe and rigid material for craniofacial bone defect and reasonable method for the reconstruction of craniofacial bone defects.
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Humans , Durapatite , Facial Bones , Foreign-Body Reaction , Seroma , Skull , Transplants , Wound HealingABSTRACT
Objective The method of bone lengthening by distraction of callus was used on dog mandible as a model to study the capability and changes of membranous bone during distraction osteogenesis. Methods 15 dogs aged 5～7 months were chosen as the subjects. The operation included a unilateral or bilateral periosteal preserving corti cotomy of mandibular bone, and an introral mini lengthening device were fixed to the buccal side of the mandible. After 7d, the mandible was lengthened lmm/d for 20d and then held in internal fixation for 7～ 140d (1 ～ 20 weeks). Results The dogs were killed at 3 times. Anthropometric measurements, X-ray examination and histological observa tion were conducted and conformed that the distracted bone had formed in the expanded zone successfully. Conclu sion The results suggested that we could use the DO technique in the area of craniofacial clinic. The strong ability of generating new bone in membranous skeleton by DO technique should be further demonstrated in the future.
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Reconstructing craniofacial bone defect is mainly done by autogenous bone graft and alloplastic implant insertion. Autogenous bone graft has the advantage of supplying the similar tissue to the bone defect area. But, due to several problems arose by using autogenous bone graft, the clinical use of the alloplastic implant has been increased. Among the various implants, titanium mesh has many advantages in chemical and physical properties. We have treated 26 patients with craniofacial bone defects (9 cases of cranium, 17 cases of orbital bone, and 9 cases of maxilla) using the titanium dynamic mesh (Howmedica Leibinger Inc.) and autogenous bone graft together in last two years. We followed up the patients for 3 to 18 months (mean, 8.2 months) and got satisfactory results with low complication rates. We found that the titanium dynamic mesh could be used successfully as an alternative substitute in reconstruction of the small to medium-sized defects in the craniofacial area. To maximize the success, certain surgical techniques had to be used. These techniques are as follow: 1.It required expertise to produce complex 3-dimensional contours of the craniofacial bone (frontal eminence, orbital margin etc.) with hand forming techniques. 2.In cranioplasty, at least 4 points fixation and enough soft tissue coverage were necessary. 3.In orbital wall reconstruction, mesh was inserted with the margins rested on the firm surrounding bone after meticulous trimming and molding to minimize complication such as enophthalmos. 4.In maxillary sinus reconstruction, attention was needed to prevent of soft tissue prolapse into the sinus and to aerate of the sinus. In conclusion, the excellent biocompatibility of titanium and easy application of the titanium dynamic mesh are outstanding characteristics in three-dimensional reconstruction of craniofacial bone defect with minimal morbidity and complications.