Reproducibility of a three-dimensional skeletal-based craniofacial orientation method for virtual surgical planning.

Inadequate craniofacial orientation of computed tomography (CT) scans can have significant implications in all three planes of space. The purpose of this study was to present the reproducibility of a 3-dimensional skeletal-based method of craniofacial orientation for virtual surgical planning. The protocol was defined by landmarks commonly used for cephalometry, and required identification of basion, nasion, right porion, and right orbitale, and navigation in all CT views (coronal, sagittal, and axial) for correction of yaw, roll, and pitch. Reproducibility of the method was assessed using eight CT scans that were randomly selected and anonymised. The observer group consisted of six oral and maxillofacial surgeons with varying levels of experience (resident or faculty) who performed craniofacial orientation according to the proposed method. Results were expected to be below 2° of variation, when overall accuracy as well as the influence of the academic level of the observers and symmetry of the evaluated anatomy, were considered as independent variables. Overall accuracy for all cases and for yaw, roll, and pitch were always below 2° of variation, without influence of level of experience and symmetry. Interobserver assessment was categorised as excellent in all instances, and intraobserver evaluation demonstrated consistency in the orientation of all axes. The proposed craniofacial orientation protocol presented in this study is easy to learn, applicable to computer-aided surgical planning, and can be performed by the non-technical clinician, resulting in excellent reproducibility and consistency.

Ankyloglossia Superior Associated With Moebius Syndrome: A Case Report.

Ankyloglossia superior is an exceedingly rare congenital condition that consists of a connection between the tongue and hard palate. This abnormality is considered part of the ankyloglossia superior syndrome when found with other malformations such as limb deformities, gastrointestinal malformation, and cleft palate. Ankyloglossia superior can also be associated with other known syndromes. We have presented the case of a female infant born with multiple malformations, including partial agenesis of the feet and hands, micrognathia, a lack of expression of the facial muscles, convergent strabismus, mouth opening limitation, and tongue-palate adhesion. The patient's presenting diagnosis was ankyloglossia superior associated with Moebius syndrome. Computed tomography revealed the extent of the ankyloglossia superior and the loss of integrity of the palatal shelf. Surgical release of the ankyloglossia superior was performed with the patient under general anesthesia. Multiple management challenges were encountered postoperatively. To the best of our knowledge, ankyloglossia superior presenting in conjunction with Moebius syndrome had not been formally described in a case report.