[New features in the management of labio-maxillo-palatal clefts at the CHUV]. / Nouveautés dans la prise en charge des fentes labio-maxillo-palatines au CHUV.

The labio-maxillofacial cleft (LMFC) penalizes the child from birth by its aesthetic, functional, psychological and social repercussions. The prognosis is conditioned by a multidisciplinary care that starts from the antenatal period to continue until the end of growth. The treatment is long and complex. This explains the multiplicity of techniques and the variability of schedules according to the teams. The purpose of this article is to describe the protocol of management of the LMFC within the multi-disciplinary team in Lausanne and to emphasize the novelties in both surgical and organizational plan.

La fente labio-maxillo-palatine (FLMP) pénalise l'enfant dès sa naissance par ses retentissements esthétiques, fonctionnels, psychologiques et sociaux. Le pronostic est conditionné par une prise en charge multidisciplinaire qui commence dès la période anténatale pour se poursuivre jusqu'à la fin de la croissance. Le traitement est long et complexe. Ceci explique la multiplicité des techniques et la variabilité des calendriers selon les équipes. Le but de cet article est de décrire le protocole de prise en charge des FLMP au sein de l'équipe pluridisciplinaire lausannoise et en mettant l'accent sur les nouveautés tant sur le plan chirurgical qu'organisationnel.

The Mandibular Ramus: An Alternative Donor Site for Secondary Alveolar Bone Grafting in Clefts of the Alveolus.

The authors describe the use of the mandibular ramus as an autologous bone graft material for secondary alveolar bone grafting in cleft patients. This technique represents a safe and effective alternative to currently used donor sites. Furthermore, it allows to minimize patient discomfort, so that they can be treated as outpatients.

The influence of involuntary facial movements on craniofacial anthropometry: a survey using a three-dimensional photographic system.

In the modern anthropometry of complex structures, such as the face, different technical approaches for acquisition of three-dimensional data have become increasingly more common. Results of meticulous evaluations have shown high degrees of precision and accuracy under both ideal and clinical circumstances. However, the question remains as to which level of accuracy is adequate to meet clinical needs. Apart from the measuring technique itself, potential sources of error must be identified and dealt with. Subjects' involuntary facial movements can potentially influence clinical reliability. The 3dMDface™ system was used clinically to investigate the influence of involuntary facial movements. Other factors of influence were systematically excluded. The mean technical error of the system (0.09mm) was investigated in a previous study and taken into account for interpretation of the data. The handling of the system was straightforward for both acquisition and analysis of data. Including technical error and the influence of involuntary facial movements, the mean global error was 0.41mm (range 0-3.3). Taking into account the technical error of the system known from the previous study, involuntary facial movements account for a mean error of 0.32mm. This range of involuntary facial movements clearly exceeds the known technical error of the three-dimensional photographic system used. Given this finding, future research should shift its focus from the analysis of the technical aspects of such systems to other influential factors.

Precision and accuracy of the 3dMD photogrammetric system in craniomaxillofacial application.

BACKGROUND: In modern anthropometry of such complex structures as the face, three-dimensional scanning techniques have become more and more common. Before establishing them as a criterion standard, however, meticulous evaluation of their precision and accuracy under both ideal and clinical circumstances is essential. Potential sources of error need to be identified and addressed. MATERIALS AND METHODS: Under ideal circumstances, a phantom is used to examine the precision and accuracy of the 3dMD system. A clinical setting is simulated by varying different parameters such as angle, distance, and system reregistration, as well as data evaluation under different levels of magnification. RESULTS: The handling of the system was unproblematic in matters of data acquisition and data analysis. It was very reliable, with a mean global error of 0.2 mm (range, 0.1-0.5 mm) for mannequin head measurements. Neither the position of the head nor that of the camera influenced these parameters. New referencing of the system did not influence precision and accuracy. CONCLUSIONS: The precision and accuracy of the tested system are more than sufficient for clinical needs and greater than those of other methods, such as direct anthropometry and two-dimensional photography. The evaluated system can be recommended for evaluation and documentation of the facial surface and could offer new opportunities in reconstructive, orthognathic, and craniofacial surgery.

High risk for hyperlipidemia and the metabolic syndrome after an episode of hypertriglyceridemia during 13-cis retinoic acid therapy for acne: a pharmacogenetic study.

BACKGROUND: Administration of 13-cis retinoic acid (isotretinoin) for acne is occasionally accompanied by hyperlipidemia. It is not known why some persons develop this side effect. OBJECTIVE: To determine whether isotretinoin triggers a familial susceptibility to hyperlipidemia and the metabolic syndrome. DESIGN: Cross-sectional comparison. SETTING: University hospital in Lausanne, Switzerland. PARTICIPANTS: 102 persons in whom triglyceride levels increased at least 1.0 mmol/L (> or =89 mg/dL) (hyperresponders) and 100 persons in whom triglyceride levels changed 0.1 mmol/L (< or =9 mg/dL) or less (nonresponders) during isotretinoin therapy for acne. Parents of 71 hyperresponders and 60 nonresponders were also evaluated. MEASUREMENTS: Waist-to-hip ratio; fasting glucose, insulin, and lipid levels; and apoE genotype. RESULTS: Hyperresponders and nonresponders had similar pretreatment body weight and plasma lipid levels. When reevaluated approximately 4 years after completion of isotretinoin therapy, hyperresponders were more likely to have hypertriglyceridemia (triglyceride level > 2.0 mmol/L [>177 mg/dL]; odds ratio [OR], 4.8 [95% CI, 1.6 to 13.8]), hypercholesterolemia (cholesterol level > 6.5 mmol/L [>252 mg/dL]; OR, 9.1 [CI, 1.9 to 43]), truncal obesity (waist-to-hip ratio > 0.90 [OR, 11.0 (CI, 2.0 to 59]), and hyperinsulinemia (insulin-glucose ratio > 7.2; OR, 3.0 [CI, 1.6 to 5.7]). In addition, more hyperresponders had at least one parent with hypertriglyceridemia (OR, 2.6 [CI, 1.2 to 5.7]) or a ratio of total to high-density lipoprotein cholesterol that exceeded 4.0 (OR, 3.5 [CI, 1.5 to 8.0]). Lipid response to isotretinoin was closely associated with the apoE gene. CONCLUSION: Persons who develop hypertriglyceridemia during isotretinoin therapy for acne, as well as their parents, are at increased risk for future hyperlipidemia and the metabolic syndrome.