A relevância da odontologia na Síndrome Treacher Collins: relato de caso / The relevance of dentistry in Treacher Collins Syndrome: case report

Treacher Collins também chamada de disostose mandibulofacial, é uma alteração genética dominante rara caracterizada pela má-formação dos ossos e tecidos da face. É uma síndrome crânio-facial que apresenta alterações bilaterais e simétricas de estruturas originadas do primeiro e segundo arcos branquiais. A maioria dos casos possui transmissão autossômica dominante e expressividade variável. O objetivo do presente estudo é realizar um relato de caso sobre o impacto do tratamento odontológico na qualidade de vida do paciente portador de Treacher Collins. Paciente, 39 anos, sexo feminino compareceu a uma clínica odontológica em Belo Horizonte, com a queixa principal de falhas dentárias e sensibilidade. Durante a anamnese a paciente relatou ter a STC, durante o exame clínico extraoral verificou a presença de hipoplasia malar e mandibular, malformação dos pavilhões auriculares com perda auditiva, obliquidade e coloboma palpebral inferior. Ao exame intraoral observou ser classe II de Angle, ausência dos dentes 11, 12, 13, 21 e 22 e extrusão do dente 41 e recessão gengival e periodontite estágio I grau A. Após exames de periodontograma e complementares foi realizado uma raspagem nas áreas com profundidade de sondagem maior que 3mm, frenectomia labial inferior, aplicação de laser para sensibilidade, enxerto gengival e colocação de prótese parcial removível. A paciente ao final do tratamento relatou ter se sentido realizada e contente com a sua conclusão, ela foi encaminhada ao Sistema único de Saúde para realizar as cirurgias para corrigir as alterações crânio-faciais. O tratamento odontológico deve ser adaptado a cada indivíduo de acordo com sua necessidade, tendo uma abordagem multidisciplinar, possibilitando uma melhora na qualidade de vida e estética do paciente(AU)

Treacher Collins syndrome is a rare dominant genetic disorder characterized by malformation of the bones and tissues of the face. It is a craniofacial syndrome that presents bilateral and symmetrical alterations of structures originating from the first and second branchial arches. The aim of the present study is to perform a case report on the impact of dental treatment on the quality of life of a patient with CTS. Patient, 39 years old, female, attended a dental clinic in Belo Horizonte, with the main complaint of dental flaws and sensitivity. During the anamnesis the patient reported having CTS, during the extraoral clinical examination she verified the presence of malar and mandibular hypoplasia, malformation of the pinnae with hearing loss, obliquity and lower eyelid coloboma. Intraoral examination revealed Angle class II, missing teeth 11, 12, 13, 21 and 22, extrusion of tooth 41, gingival recession and stage I periodontitis grade A. After periodontogram and complementary exams it was performed a scaling in areas with a probing depth greater than 3mm, lower lip frenectomy, laser application for sensitivity, gingival graft and placement of partial removable prosthesis. The patient at the end of treatment reported feeling fulfilled and happy with its completion, she was referred to the Unique Health System to undergo surgery to correct the craniofacial changes. The current treatment aims at functional and aesthetic correction and the need for psychosocial support, having the joint participation of a multidisciplinary team to achieve this goal(AU)

Displasia frontonasal / Frontonasal dysplasia

Los trastornos del desarrollo son aquellos padecimientos que se manifiestan por defectos en la embriogénesis de la región afectada. La cara del ser humano comienza su formación alrededor de la cuarta semana de vida intrauterina y se manifiesta gracias a la fusión de cinco prominencias: dos pares conocidas como maxilar y mandibular, y una impar conocida como frontonasal. Cuando esta fusión no se lleva a cabo de una forma óptima, aparecen numerosas alteraciones del desarrollo como el labio y paladar hendido, y la displasia frontonasal. La displasia frontonasal produce frecuentemente afecciones oculares, nasales y orales. Dentro de las manifestaciones orales destacan una forma atípica de hendidura labial o palatina, afecciones dentales y alteraciones en el crecimiento de la cara. Dada la gran relación que este padecimiento tiene con la cavidad oral resulta importante que el odontólogo conozca la etiología y las características clínicas de este trastorno (AU)

Developmental disorders are those conditions that are manifested by defects in the embryogenesis of the affected region. The human face begins its formation around the fourth week of intrauterine life and is manifested thanks to the fusion of five prominences: two pairs known as maxillary and mandibular and odd one known as frontonasal. When this fusion is not carried out in an optimal way, numerous developmental alterations appear, such as cleft lip and palate and frontonasal dysplasia. Frontonasal dysplasia frequently produces ocular, nasal and oral affections. Among the oral manifestations, and atypical form of clef lip and/or palate, dental affections and alterations in the growth of the face stand out. Given the great relationship that this condition has with the oral cavity, it is important for the dentist to know the etiology and clinical characteristics of this disorder (AU)

Métodos de avaliação cognitiva de pacientes com Síndrome de Apert e de Crouzon / Cognitive assessment methods of patients with Apert and Crouzon syndrome

A Craniossinostose Coronal bilateral implica em diminuição do Perímetro Craniano (PC) no eixo ântero-posterior (Braquicefalia) e frequentemente se associa ao aumento do eixo céfalo-caudal (vertical-altura) do crânio (Turricefalia), sendo um dos achados mais comuns nas Síndromes de Crouzon e Apert. Objetivo: Identificar, analisar e sintetizar os métodos de avaliação cognitiva apropriados para o acompanhamento da evolução de pacientes com cranioestenoses sindrômicas, em particular as síndromes de Apert e de Crouzon. Método: Trata-se de uma revisão de escopo. Para a formulação da pergunta norteadora da pesquisa e da estratégia de busca, foi utilizada a estratégia Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] e Context (em qualquer contexto). Foram inclusos os artigos escritos em inglês, português e espanhol em qualquer período. A busca foi realizada nas bases de dados: Embase, Scopus, PubMed/MEDLINE e rede BVS Salud. Resultados:Inúmeros testes de avaliação cognitiva validados internacionalmente foram aplicados aos pacientes com Apert e Crouzon, mas não se observou uma padronização (protocolo) seguida pelas várias unidades de assistência. Dos 75 tipos de Testes Cognitivos aplicados houve o predomínio da Escala de Inteligência de Wechsler (e seus subtestes), 50%. Na população avaliada predominou duas faixas etárias: escolares e adolescentes. As crianças com Apert e Crouzon obtiveram escores piores nos transtornos de socialização, atenção e internalização quando comparadas com o grupo normativo, sendo os piores resultados encontrados em Apert. Fatores que interferem no desenvolvimento neuropsicomotor: pressão intracraniana, malformações encefálicas, genética, idade na correção cirúrgica (postergação da primeira cirurgia após um ano de idade associou-se a um quociente de inteligência mais baixo), institucionalização, ambiente familiar, escolaridade dos cuidadores e nível socioeconômico. Considerações finais: os resultados obtidos contribuíram para maior conhecimento do perfil cognitivo dos pacientes com estas síndromes. Somente conhecendo as habilidades e dificuldades neuropsicomotoras, cognitivas e psicossociais dos pacientes com Apert e Crouzon é que as equipes de saúde, da escola e de cuidadores poderão entender melhor a capacidade perceptiva destes no processo de aprendizado e estarão mais aptas em atender as necessidades especiais destes pacientes e poderão ofertar os estímulos mais adequados no momento mais oportuno (AU).

Bilateral Coronal Craniosynostosis implies a decrease in the Cranial Perimeter (CP) in the anteroposterior axis (Brachycephaly) and is frequently associated with an increase in the cephalocaudal (vertical height) axis of the skull (Turrycephaly); being one of the most common findings in Crouzon and Apert Syndromes (Syndromic Craniosynostosis). In this Scope Review study, among the Syndromic Craniosynostosis, Apert and Crouzon Syndromes will be of special interest. Objective: This study aimed to identify, analyze, and synthesize the appropriate cognitive assessment methods for monitoring the evolution of patients with syndromic craniosynostosis, in particular Apert's and Crouzon's syndromes. Method: This is a scope review. In order to formulate the research guiding question and the searching strategy, the Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] and Context (in any context) strategy was used. The articles written in English, Portuguese, and Spanish in any period were included. The search was performed in the following databases: Embase, Scopus, National Library of Medicine (PubMed/MEDLINE), and in the BVS Salud network (PAHO, WHO, BIREME, LILACS). Results: many internationally validated cognitive assessment tests were applied to patients with Apert and Crouzon, but no standardization (protocol) was followed. Of the 75 types of Cognitive Tests applied, the Wechsler Intelligence Scale predominated, 50%. In the evaluated population, two age groups predominated: school children and adolescents. Children with Apert and Crouzon had worse scores on disorders of socialization, attention, and internalization when compared to the normative group, with the worst results found in Apert. Factors that interfere with cognitive development: intracranial pressure, brain malformations, genetics, age at surgical correction, institutionalization, family environment, caregiver education, and socioeconomic status. Conclusion: the results contributed to a better understanding of the cognitive profile of patients with these syndromes and only by knowing about the neuropsychomotor, cognitive, and psychosocial skills and difficulties of these patients with Apert and Crouzon that health, school, and caregiver teams will be able to understand the perceptive capacity in the learning process of these patients deeply and will be able to offer the most appropriate stimuli at the most opportune time. Keywords: Apert, Crouzon, Neuropsyc, Tests, Development (AU).

Craneosinostosis sindrómica: Características craneodentofaciales, tratamiento ortodón-tico-quirúrgico y factores asociados a tipos de síndrome / Craniossinostose sindrômica: Características craniodentofaciais, tratamento ortodônti-co-cirúrgico e fatores associados aos tipos de síndrome / Syndromic Craniosynostosis: Craniodentofacial features, orthodontic-surgical treatment and factors associated to types of syndrome

Objetivos: Describir las características craneodentofaciales, tratamientos ortodónticos-quirúrgicos y establecer una aso-ciación entre los tipos de síndrome presentes en pacientes con craneosinostosis sindrómica (CS). Material y métodos: Estudio retrospectivo de registros médicos y de ortodoncia de pacientes con CS. Los datos se recogieron en una forma específica y se sometieron a un análisis estadístico descriptivo para observar la distribución de frecuencias y se utilizó la prueba de Chi cuadrado con un nivel de significación del 5% para asociar el síndrome y los tipos de variables. Resultados: El síndrome de Crouzon fue el tipo predominante (59.2%) y la braquicefalia fue el tipo más frecuente de craneosinostosis (63.6%). Hubo una asociación significativa entre las variables braquicefalia (p = 0,014), presencia de paladar hendido (p = 0,043), mordida cruzada posterior (p = 0,013), distracción osteogénica realizada por elásticos intermaxilares (p = 0,030), barra de Erich (p = 0.007) y la extracción (p = 0.041) y los síndromes estudiados. Conclusión: Los pacientes con CS a menudo tienen cambios craneodentofaciais y algunas variables tienen asociaciones significativas en relación con los tipos de síndromes.

Objectives: Describe the craniodentofacial characteristics, orthodontic-surgical treatments and establish an association between the syndrome types present in patients with syndromic craniosynostosis (SC). Material and methods: Retros-pective study of medical and orthodontic records of patients with SC. Data was collected on a specific form and subjected to descriptive statistical analysis to observe the distribution of frequencies and chi-square test with level of significance of 5% was used to associate syndrome and the types of variables. Results: Crouzon syndrome was the predominant type (59.2%) and brachycephalia was the most prevalent type of craniosynostosis (63.6%). There was a significant association between the variables brachycephaly (p=0.014), presence of cleft palate (p=0.043), posterior cross bite (p=0.013), distrac-tion osteogenesis performed by intermaxillary elastics (p= 0.030), Erich bar (p= 0.007) and extraction (p=0.041) and the syndromes studied. Conclusion: Patients with SC often have craniodentofaciais changes and some variables had signifi-cant associations in relation to the types of syndromes.

Descrever as características craniodentofaciais, tratamentos ortodôntico-cirúrgicos e estabelecer uma associação entre os tipos de síndrome presentes em pacientes com craniossinostose sindrômica (CS). Material e métodos: Estudo retrospectivo de prontuários médicos e ortodônticos de pacientes com CS. Os dados foram coletados em formulário específico e submetidos à análise estatística descritiva para observar a distribuição das frequências e o teste qui-quadrado com nível de significância de 5% foi utilizado para associar a síndrome e os tipos de variáveis. Resultados: A síndrome de Crouzon foi o tipo predominante (59,2%) e a braquicefalia foi o tipo mais prevalente de craniossinostose (63,6%). Houve associação significativa entre as variáveis braquicefalia (p = 0,014), presença de fissura de palato (p = 0,043), mordida cruzada posterior (p = 0,013), distração osteogênica realizada pelos elásticos intermaxilares (p = 0,030), barra de Erich (p= 0,007) e extração (p = 0,041) e as síndromes estudadas. Conclusão: Pacientes com CS frequentemente apresentam alterações craniodentofaciais e algumas variáveis apresentaram associações significativas em relação aos tipos de síndromes.

Syndromic craniosynostosis: neuropsycholinguistic abilities and imaging analysis of the central nervous system / Craniossinostoses sindrômicas: habilidades neuropsicolinguísticas e análise por imagem do sistema nervoso central

ABSTRACT Objective: To characterize patients with syndromic craniosynostosis with respect to their neuropsycholinguistic abilities and to present these findings together with the brain abnormalities. Methods: Eighteen patients with a diagnosis of syndromic craniosynostosis were studied. Eight patients had Apert syndrome and 10 had Crouzon syndrome. They were submitted to phonological evaluation, neuropsychological evaluation and magnetic resonance imaging of the brain. The phonological evaluation was done by behavioral observation of the language, the Peabody test, Token test and a school achievement test. The neuropsychological evaluation included the WISC III and WAIS tests. Results: Abnormalities in language abilities were observed and the school achievement test showed abnormalities in 66.67% of the patients. A normal intelligence quotient was observed in 39.3% of the patients, and congenital abnormalities of the central nervous system were observed in 46.4% of the patients. Conclusion: Abnormalities of language abilities were observed in the majority of patients with syndromic craniosynostosis, and low cognitive performance was also observed.

RESUMO Objetivo: Caracterizar as habilidades neuropsicolinguísticas de indivíduos com craniossinostoses sindrômicas e apresentar esses achados com as anomalias do sistema nervoso central. Métodos: Participaram do estudo 18 sujeitos com diagnóstico clínico de craniossinostose sindrômica, 44,4% com a síndrome de Apert e 55,6% síndrome de Crouzon. Todos os sujeitos foram submetidos a avaliação fonoaudiológica, psicológica e exames de ressonância magnética do encéfalo. A avaliação fonoaudiológica foi contemplada pela Observação Comportamental da Linguagem, Teste Peabody (TVIP), Teste Token e Teste de Desempenho Escolar (TDE); enquanto a psicológica utilizou a WISC-III e a WAIS. Resultados: Observou-se alteração nas habilidades de linguagem em todos os protocolos utilizados, sendo o TDE o que apresentou maior porcentagem de alteração (66,67%).A avaliação cognitiva evidenciou quociente de inteligência dentro da média em 39,3% dos sujeitos, enquanto que 46,4% apresentaram malformações congênitas do sistema nervoso central. Conclusão: Constatou-se alterações nas habilidades de linguagem na maioria dos sujeitos com craniossinostoses sindrômicas, bem como o baixo desempenho cognitivo.

Tratamientos ortopédicos y ortodóncicos de pacientes con síndromes poco comunes: protocolo / Orthopedic and orthodontic treatments of patients with unusual syndromes: a protocol

Son muchos los síndromes que manifiestan alteraciones dento-esqueletales y, a su vez, manifiestan diferentes complicaciones, no permitiendo tener un protocolo definido para cada síndrome. Para establecer un adecuado protocolo de tratamiento, basado en tratamientos realizados exitosamente y tomando en cuenta los fracasos para no incurrir en el mismo error, se hizo una revisión bibliográfica desdemayo hasta septiembre de 2012, de artículos publicados en los últimos diez (10) años, de revistas internacionales de ortodoncia, ortopedia y cirugía maxilofacial que registraban estudios de investigación y casuística, en buscadores científicos como PubMed, Scielo, Medline. Posteriormente, se tomó la clasificación de Kenneth Lyons Jones, MD, en su obra literaria Patrones Reconocibles de Malformaciones Humanas (2007), tomando en cuenta para la elaboración de este trabajo, los que presentan craneosinostosis, defectos faciales mayores y defectos faciales y de las extremidades como características mayores, que ameritan tratamiento para corregir problemas dento-esqueletales. De los 39 artículos se seleccionaron 11 que tenían relevancia con su tema. Conocer y describir todos los síndromes, mencionando cada característica, es de suma importancia para los profesionales de la salud, ya que de ellos depende no sólo el correcto diagnóstico, sino el tratamiento más adecuado...

Genetic Syndromes Associated with Craniosynostosis

Craniosynostosis is defined as the premature fusion of one or more of the cranial sutures. It leads not only to secondary distortion of skull shape but to various complications including neurologic, ophthalmic and respiratory dysfunction. Craniosynostosis is very heterogeneous in terms of its causes, presentation, and management. Both environmental factors and genetic factors are associated with development of craniosynostosis. Nonsyndromic craniosynostosis accounts for more than 70% of all cases. Syndromic craniosynostosis with a certain genetic cause is more likely to involve multiple sutures or bilateral coronal sutures. FGFR2, FGFR3, FGFR1, TWIST1 and EFNB1 genes are major causative genes of genetic syndromes associated with craniosynostosis. Although most of syndromic craniosynostosis show autosomal dominant inheritance, approximately half of patients are de novo cases. Apert syndrome, Pfeiffer syndrome, Crouzon syndrome, and Antley-Bixler syndrome are related to mutations in FGFR family (especially in FGFR2), and mutations in FGFRs can be overlapped between different syndromes. Saethre-Chotzen syndrome, Muenke syndrome, and craniofrontonasal syndrome are representative disorders showing isolated coronal suture involvement. Compared to the other types of craniosynostosis, single gene mutations can be more frequently detected, in one-third of coronal synostosis patients. Molecular diagnosis can be helpful to provide adequate genetic counseling and guidance for patients with syndromic craniosynostosis.

Sindrome de Crouzon: Revisión de tema y reporte de caso / Crouzon's Syndrome: Review of the literature and case report

Síndrome de Crouzon es una sinostosis craneofacial congénita caracterizada por el cierre prematuro intrauterino de las suturas coronal, sagital y lambdoidea lo que pro- duce un crecimiento anormal del cráneo, hipoplasia maxilar y asimetría facial. Se reporta el caso de una niña de cinco años de edad con Síndrome de Crouzon, quien consulta el servicio de Odontología Pediá- trica de la Escuela de Odontología de la Universidad del Valle (Cali, Colombia). Se destaca el abordaje multidisciplinario y el manejo ortopédico pre-quirúrgico, colocan - do un dispositivo intraoral fijo de expansión controlada con tornillo tipo Hyrax junto a una máscara facial de protracción maxilar como terapéutica previa a cirugía en mono- block y avance con distractor osteogénico

Crouzon's Syndrome: Congenital cranios- ynostosis characterised by the premature in-utero closure of the coronal, sagittal, and lambdoid sutures. It produces an abnormal growth of the cranium, hypoplasia of the jaw, and facial asimmetry. The case of a five year old girl with Crouzon Syndrome is presented; she consulted the service of Paediatric Dentistry at School of Dentistry of Universidad del Valle (Cali, Colombia). This work highlights the multidisciplinary approach and the orthopaedic pre-surgical management performed, it involved an intraoral fixed device for controlled expan - sion with a Hyrax type screw and a facial mask for maxillary protraction as treatment before surgery. The surgery was performed in mono-block and advancement with an osteogenic distactor was done.

Genetic Autosomal Dominant Disorders: A Knowledge Review / Trastornos Autosómicos Dominantes: Una Revisión de los Conocimientos

Genetic disorders occur by excess or absence of chromosomal material, and the consequence of these changes is reflected in morphological and physiological changes. Autosomal disorders, which have dominant inheritance, as cleidocranial dysostosis, Craniofacial syndrome Apert, Treacher Collins and Achondroplasia have peculiar and similar characteristics. Because of their implications in the dental field, the aim of this review is to report on dysostoses, through exposure of general clinical factors and highlighting the signs in the oral cavity. Articles were selected from Lilacs, PubMed and Bireme databases, included in the year 2007­2014, and the keywords were: cleidocranial dysplasia, craniofacial dysostosis, mandibulofacial dysostosis, dysostosis and oral. Alterations of maxillofacial bones and craniofacial are well documented in the literature, but studies reporting an association between treatment odontologic and dysostoses are scarce. In conclusion, Oral pathological manifestations developed cause difficulty in speech, chewing, breathing, social involvement, and in a general perspective, psychological impairment and physical limitations.

Las enfermedades genéticas se producen debido a un exceso o ausencia de material cromosómico, y la consecuencia de estos cambios se refleja en los cambios morfológicos y fisiológicos. Trastornos autosómicos dominantes que tienen herencia dominante, como la disostosis cleidocraneal, el síndrome craneofacial de Apert, Treacher Collins y acondroplasia tiene características peculiares y similares. Debido a sus implicaciones en el campo de la odontología, el objetivo de esta revisión es hablar, a través de la exposición de los factores clínicos y generales, destacando los signos en la cavidad oral. Se seleccionaron los artículos de las bases de datos Lilacs, PubMed y BIREME, incluyendo los años 2007-2014, y las palabras clave fueron: displasia cleidocraneal, craneofacial mandibulofacial disostosis, disostosis y oral. Los cambios de huesos maxilofaciales y craneofaciales están bien documentados en la literatura, pero los estudios que informaron una asociación entre el tratamiento dental y disostosis son escasos. En conclusion, las manifestaciones orales son causas de dificultades del habla, masticación, respiración y la participación social.

Correction of hypotelorism in craniofacial deformity / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of hypotelorism.</p><p><b>METHODS</b>From Jan. 2000 to Jan. 2014, 6 cases with hypotelorism were retrospectively studied. Among them, 3 cases had craniosynostosis, 2 had holoprosencephaly, and 1 had cleft lip. All the cases were diagnosed and treated by bone graft or spring distraction to correct the hypotelorism.</p><p><b>RESULTS</b>2 cases were treated by none graft and 4 cases were treated by external spring distraction. All the patients completed the treatment successfully with obvious improvement in appearance. No complication happened. 4 cases were followed up for 2 years with an average fronto-orbital axis angle as (50 ± 8) °.</p><p><b>CONCLUSIONS</b>Hypotelorism can be successfully corrected by bone graft as fronto-orbital bridge or spring distraction.</p>

Estudio de resonancia magnética del Síndrome de Crouzon. Reporte de caso / Crouzon's Syndrome evaluation with MRI. A case report

El Síndrome de Crouzon es una disostosis cráneo-facial poco frecuente que generalmente se diagnostica en las etapas precoces de la vida. Se presenta el caso de una lactante de dos meses de edad, estudiando mediante Resonancia Magnética en CEREMA, (Centro de Resonancia Magnética) y una revisión de la literatura acerca de esta patología.

Síndrome de Crouzon: características clínicas. Relato de casos clínicos / Crouzon Syndrome: clinical features. Clinical case reports

A Síndrome de Crouzon é uma doença hereditária que surge com o fechamento prematuro das suturas da base do crânio, resultando em um crescimento compensatório na direção em que as suturas permanecem abertas. A síndrome é caracterizada por deformidade craniofacial com redução do comprimento das bases anterior e posterior do crânio, tendo como principais características clínicas a exoftalmia, hipertelorismo e a hipoplasia do terço médio da face. / Objetivo / Relatar os casos clínicos de uma família, onde três de seus membros são portadores da Síndrome de Crouzon, apresentando, assim, as características clínicas e as formas de tratamento. / Relato / No caso 1, a paciente foi submetida à cirurgia de avanço frontofacial convencional; e nos casos 2 e 3, os pacientes foram submetidos ao avanço frontofacial com distração osteogênica. Todos foram operados em idade precoce, necessitando de tratamento ortodôntico e cirúrgico para finalização do caso. / Conclusão / Os tratamentos cirúrgico, ortopédico e ortodôntico são uma combinação perfeita para a correção das deformidades craniofaciais, sendo a distração osteogênica do terço médio da face uma técnica cirúrgica de grande sucesso, que apresenta menor morbidade e excelentes resultados.

Application of three-diinensional CT in the treatment of oblique facial clefts with mandibular outer cortex / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of three-dimensional CT(3D-CT) in the treatment of oblique facial clefts with mandibular outer cortex, including the surgical design and results assessment.</p><p><b>METHODS</b>From Jan. 2003 to Dec. 2013, 22 cases with oblique facial cleft, who underwent mandibular outer cortex onlay bone graft were retrospectively studied. 3D images from CT data were reconstructed before operation for design. Then the mandibular outer cortex onlay bone transplant was performed to reconstruct the bone defect and cleft. 3D CT was performed 5-10 days postoperatively and 6- 12 months postoperatively to assess the facial symmetry.</p><p><b>RESULTS</b>According to the results of CT measurement, the average volume of the orbital bone defects on the affected side decreased by(64. 6 ± 14. 4)% 5 to 10 days after operation. The average volume of the maxillary and zygomatic bone defects on the affected side decreased by(71.4 ± 15.7)% after surgery. After 6 to 12 months,the average recovery of the mandibular donor site was (57. 9 ± 13. 9)% of the removed mandibular outer cortex. The average absorption of grafted bones was(24.7 ± 25.6 )%. The average height difference between the centre of pupils on both sides before surgery was(3.76 ± 1.27) mm,which decreased to( 1. 15 ± 1.00) mm 5 to 10 days after surgery(P =0. 000) , and( 1.35 ± 1. 13) mm 6 to 12 months after surgery(P = 0. 003). The relapse may be caused by the absorption of the grafted bones.</p><p><b>CONCLUSIONS</b>3D-CT can be used for preoperative design and postoperative assessment in the treatment of oblique facial cleft with mandibular outer cortex.</p>

Analysis of FGFR2 gene mutations in two Chinese families with Crouzon syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To detect potential mutations of fibroblast growth factor receptor 2 gene (FGFR2) in two Chinese families with Crouzon syndrome.</p><p><b>METHODS</b>Genomic DNA was extracted from peripheral blood leukocytes of 20 members from two affected families. All of the 18 exons of the FGFR2 gene were amplified with polymerase chain reaction and sequenced after purification.</p><p><b>RESULTS</b>A missense mutation c.868T>C (p.W290R) in exon 8 of the FGFR2 gene was found solely in 2 affected members from family 1. Another missense mutation c.833G>T (p.C278F) in exon 8 was found solely in 5 affected members of family 2.</p><p><b>CONCLUSION</b>The missense mutations of the FGFR2 gene are responsible for the Crouzon syndrome in the two families. The c.868T>C missense mutation is reported for the first time in Chinese population.</p>

Características dento-faciales en los pacientes con microsomía hemifacial. Revisión de literatura / Dentofacial characteristics of patients with hemifacial microsomia. A literature review

La Microsomía Hemifacial es una altera - ción congénita que comúnmente se presenta en los tejidos blandos y duros de una mitad de la cara con características específicas que definen su diagnóstico haciendo clara su diferencia con otras patologías similares. El objetivo de esta revisión es reconocer en la clínica las características de la microsomía hemifacial para llevar a cabo un correcto diagnóstico. Se realizó una búsqueda en las bases de datos (Scielo, Medline, Science Direct) con las palabras claves: Microsomía Hemifacial, tejidos Blandos, tejidos Óseos). Se obtuvo de la búsqueda de la literatura 64 artículos, con la que se pretendió encontrar información que evaluara los diagnósticos diferencia - les de microsomía hemifacial en tejidos blandos y tejidos duros. El profesional clínico debe reconocer la asociación con síndromes para el tratamiento de la MHF, de esa forma el proceso terapéutico puede cambiar, y debe establecer la severidad de la patología en sus diferentes tejidos para su futura recuperación y establecimiento del plan de tratamiento. El buen diagnóstico y la caracterización de la misma darán un adecuado plan de tratamiento.

The Hemifacial Microsomía is a congeni - tal disorder that commonly occurs in the hard and soft tissues of half of the face with specific characteristics that define its diagnosis, making clear its difference from other similar diseases. The aim of this review is to recognize the clinical features of Hemifacial Microsomía to perform a correct diagnosis. A search was conducted in the databases (Scielo, Medline, Science Direct) with keywords: Hemifacial Micro- somía, Soft tissue, Bone tissue). Sixty four papers assesed the differential diagnosis of HFM. The clinician must recognize the as- sociation with syndromes to treat the HFM, thus the therapeutic process can change, and establish the severity of the disease in different tissues for future retrieval and treatment plan.

Síndrome de Crouzon: presentación de un caso / Crouzon syndrome: case report

Es una displasia ósea no letal caracterizada por cierre prematuro de las suturas coronales, hipoplasia de la parte media de la cara y proptosis ocular. Son los defectos congénitos del cráneo más frecuentes en humanos. El síndrome de Crouzon tiene una prevalencia de 15 en 1 x 106 nacimientos. Existen varias teorías que intentan explicar su patogenia. Hipótesis más actuales sugieren que el defecto se produce por una mutación del gen que codifica el receptor del factor del crecimiento fibroblástico tipo 2 (FGFR2). Los hallazgos ecográficos incluyen braquicefalia, oxicefalia, hipertelorismo e hipoplasia de la zona media de la cara. La sensibilidad del ultrasonido para detectar anomalías craneofaciales depende mucho del operador. La ecografía 3D no incrementa la tasa de detección de la 2D. Recientes estudios radiográficos revelaron frecuentes malformaciones intrauterinas no diagnosticadas. El diagnóstico prenatal se puede realizar por técnicas moleculares. La evolución posnatal es variable.

Anesthetic management of a patient with Freeman-Sheldon syndrome: case report and literature review / 中华医学杂志(英文版)

The Freeman-Sheldon syndrome (FSS) is a rare congenital syndrome, characterized with myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations often require orthopedic and plastic surgery. We reported a case of 8-year-old girl with FSS operated on for scoliosis.

Sindrome de Crouzon: diagnóstico radiográfico y tratamiento ortognático de un caso clínico / Crouzon´s syndrome: radiographic diagnosis and orthognathic treatment of a clinical case

El síndrome de Crouzon es un defecto de origen congénito que se caracteriza por malformaciones en el desarrollo, ligado al cierre prematuro de las suturas craneales que producen severos cambios en la conformación de la cara y cráneo. El objetivo de este trabajo es presentar un caso clínico de un paciente con síndrome de Crouzon de 17 años de edad, sexo femenino. Se analizan los diagnósticos clínico, radiográfico y elt ratamiento ortodóntico-quirúrgico.

Multidrug-Resistant Streptococcus pneumoniae Sepsis and Meningitis after Craniofacial Surgery: Case Report

PURPOSE: The prevalence of antibiotic-resistant Streptococcus pneumoniae meningitis has increased worldwide. There are some reports about postoperative antibiotic-resistant Streptococcus pneumoniae infection after craniofacial surgery, but, there is no report in Korea. We present a report on the treatment of postoperative multidrug-resistant Streptococcus pneumoniae (MRSP) meningitis and sepsis after craniofacial surgery based on our experience. METHODS: The patient was a 7-year-old boy with Crouzon's disease who was treated by fronto-orbital bar advancement. Intraoperatively, frontal sinus opening was seen during osteotomy which was covered with forehead galeopericranial flap. MRSP meningitis was diagnosed after the surgery, he was treated with intravenous vancomycin, meropenem, and levofloxacin. RESULTS: The patient was treated successfully after 3 weeks of intravenous antibiotics treatement. During the 8 month follow-up period, there was no neurologic sequelae. CONCLUSION: Postoperative infection after craniofacial surgery is an important phenomenon that needs immediate recognition. Prevention, early diagnosis, and treatment immediate after onset are important as countermeasures against postoperative drug-resistant bacterial infection. To prevent adverse outcome and reoperation, proper antibiotics treatment should be performed.

Segmental monobloc osteotomy and bi-directional distraction for the treatment of Crouzon syndrome in an infant / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the segmental monobloc osteotomy and bi-directional distraction for the treatment of Crouzon syndrome in an infant.</p><p><b>METHODS</b>A 9-month-old female infant underwent monobloc osteotomy through combined intra- and extra-cranial way. The facial skull was divided into frontal, orbital and maxillary segments. The external distractor was used to move the frontal segment, orbital segment and midface forward. The internal distractor was used to move the maxilla downward. The consolidation lasted for 3 months after distraction.</p><p><b>RESULTS</b>The osteotomy and distraction were successfully completed. The distraction distance reached 18 mm, showing by distractor. The real distraction distance of facial bone was 12 mm, documented by 3-D image. The skull deformity and severe depression of midface improved a lot. The exophthalmos and underbite were corrected. The obstructive sleep apnea also improved markedly. However, the downward movement of maxilla was limited.</p><p><b>CONCLUSIONS</b>Monobloc osteotomy with external distractor, as well as maxillary distraction, could be used for Crouzon syndrome in infant. It is safe and effective method which can be performed in an early age for Crouzon syndrome with obstructive sleep apnea.</p>