Osseointegration in sinus-forming bone.

Osseointegration, using bone-anchored titanium fixtures, is a well-established technique for both intraoral and craniofacial prosthetic rehabilitation. The use of this technique in children can be complicated by craniofacial growth and sinus development. This study evaluates the effects of sinus formation and growth on the fate of osseointegrated titanium fixtures in the growing porcine model. At 3 weeks of age, six Landrace White cross male pigs had a 3.75 x 3.0 mm titanium fixture (Noblepharma) inserted into their right frontal bone where the right frontal sinus would subsequently develop. Preoperative CT scans with three-dimensional reconstructions were used to determine the insertion site. To follow the effects of growth and sinus formation, CT scans with three-dimensional reconstructions and cephalometric radiographs were taken at 1, 3, 6, and 9 weeks postoperatively and at sacrifice. The pigs were sacrificed serially, and direct osteometric measurements were taken to determine skull symmetry. All skulls were sectioned, and osseointegration was determined clinically, radiologically, and histologically with light and scanning electron microscopy. Five of the six fixtures osseointegrated. There were no apparent growth disturbances due to the fixtures. As growth progressed, the osseointegrated fixtures submerged into the frontal bone in a posteroinferior direction to become completely intraosseous 14 weeks after insertion. As the frontal sinus pneumatized, the fixtures remained osseointegrated, but progressive amounts of the fixtures became exposed in the sinus. From this study it would appear that osseointegrated titanium fixtures do not have any effect on calvarial growth and gradually submerge into the growing bone. As sinus development ensues, the fixtures remain integrated but become partially exposed within the sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental calvarial growth disturbance by micro-plate and screw fixation.

A study was designed to help ascertain the effects of rigid internal fixation in the growing skull. Five piglets underwent plating of the left coronal suture at 3 weeks of age. At the time of surgery metal markers were placed to follow bone growth. Cephalometric radiographs, direct osteometry at sacrifice, gross pathological examination and specimen radiography revealed a localized disturbance of growth. There was a restriction of sutural displacement and appositional bone growth at the site of the plate. Local restriction of sutural growth was almost complete during the experimental period. There was an alteration to a 'mature' suture morphology, without synostosis, of the suture on the plated side not seen on the control side. A plagiocephalic pig was not produced nor was there an orbital deformity. A large local contour deformity developed and by the end of the experimental period the plate had become completely incorporated in bone. These effects were statistically significant as well as clinically significant. The clinical use of this type of fixation in reconstructive surgery of the infant craniofacial skeleton is questioned in light of the result.

Craniofacial growth in unilateral cleft lip and palate: skeletal growth from eight to eighteen years.

Sixteen individuals with complete unilateral cleft lip and palate (UCLP) were evaluated for determination of several craniofacial dimensional means and growth rates. Each had undergone primary lip and palatal closure and alveolar bone grafting. Serial cephalographs from ages 8 to 18 years, taken every 2 years, were utilized for determination of six cephalometric dimensions: anterior cranial base, upper and lower facial heights, posterior nasomaxillary height, maxillary horizontal length, and mandibular length. These were then compared to published cephalometric standards of a nonclefted group. All dimensions, except mandibular length, were smaller in the UCLP group. The horizontal maxillary length was the most diminished in mean length and growth rate; it appears to be most affected in UCLP. The remaining dimensions and growth rates are affected by UCLP, but to a lesser degree. These findings indicated that individuals with unilateral cleft lip and palate are primarily and adversely affected by clefting (and the surgery as described) in the horizontal maxilla, both in dimension and growth rate.

Cephalometric and anthropomorphic observations of Binder's syndrome: a study of 19 patients.

Binder's syndrome (maxillonasal dysplasia) is a disorder characterized by nasomaxillary hypoplasia. To ascertain the extent of underdevelopment of the midfacial skeleton and soft tissues, 19 of 29 patients with Binder's syndrome were retrospectively evaluated, both with cephalometry and anthropometry. Ten females and nine males were placed collectively into three age groups: 6 years, 10 years, and 16 to 17 years. Cephalometric measurements disclosed a short anterior cranial base (S-N), a normal length of the vertical maxilla (SE-PNS), a decreased horizontal maxilla (PNS-A, Co-A), a recessed orbitale (SNO), and a high-normal mandibular length (Co-Gn). Anthropometry revealed a large nasofrontal angle, acute nasal inclination and nasolabial angle, decreased nasal prominence (Sn-Prn), a decreased columellar length (C-Sn), and a normal vertical nose (N-Sn) and upper lip (Sn-Sto) length.

Maxillonasal dysplasia (Binder's syndrome): a critical review and case study.

Binder's syndrome (maxillonasal dysplasia) is a disorder of unknown etiology characterized by nasomaxillary hypoplasia and a 40-50% association of an underdeveloped frontal sinus and cervicospinal abnormalities. The midfacial retrusion is similar to that in chondrodysplasia punctata, resulting in confusion regarding diagnosis. This paper outlines the distinguishing features of Binder's syndrome, the treatment considerations, and presents 24 patients seen and treated. The facial and skeletal characteristics and developmental findings are emphasized to affirm the diagnosis of Binder's syndrome. A familial finding of Binder's features in five patients raises the possibility of a genetic mechanism, a previously undisclosed finding.

Embolization of traumatic aneurysm of the maxillary artery.

An expanding false aneurysm in the infratemporal fossa followed this patient's complicated jaw fracture. Successful Gelfoam embolization of the maxillary artery has controlled haemorrhage, treated the aneurysm, and avoided the hazards of local operative intervention. The technique of embolization has a place in the management of various difficult vascular problems.