Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study.

BACKGROUND: Detection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint. PURPOSE: The purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age. STUDY DESIGN, SETTING, SAMPLE: A single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Age (in months) at the time of presentation, measured as a continuous variable. MAIN OUTCOME VARIABLE(S): The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant's mouth and applies slight pressure to encourage MMO. In older infants with erupted central incisors, MMO was measured from the gingival margins. COVARIATES: The covariates were sex, race, and gestational age. ANALYSES: Findings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age. RESULTS: The sample was composed of 151 infants with a mean age of 5.2 months (95% confidence interval [CI] 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, P < .001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4 to 23.6), compared to a mean of 36.7 mm (95% CI 34.8 to 38.6) in infants 11 months of age. CONCLUSIONS AND RELEVANCE: The results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Overjet in Infants: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to determine the normal ranges for overjet in healthy infants under 12 months of age. DESIGN: A cross sectional study of consecutive patients below 12 months of age. SETTING: The study was conducted at a private practice in Tampa, FL that specializes in pediatric craniomaxillofacial disorders. PATIENTS: All patients under the age 12 months were considered for entry into the study. Patients were excluded if they had temporomandibular joint pathology, sleep disordered breathing, facial trauma, or were diagnosed with a craniofacial anomaly. INTERVENTIONS: Measures of overjet, defined as the distance between the anterior surfaces of the alveolar ridges when in centric relation, were obtained. MAIN OUTCOME MEASURE: The primary study outcome was the overjet of the enrolled patients. RESULTS: A total of 152 infants were included in this study. Of these, 51 were female, and 40 were born prematurely (ranging from 32-37 weeks of gestation). In neonates below 1 month of age, the mean overjet was 2.25 mm (95% CI 1.31-3.19). Multivariate linear regression analysis showed overjet to significantly decrease with age, at a mean rate of approximately 0.1 mm per month (coefficient of -0.09, 95% CI -1.61 to -0.02, p = 0.01). When controlling for potential confounders, average overjet was not shown to vary significantly between the sexes, with prematurity, with race, or with primary diagnosis at presentation. CONCLUSION: This paper establishes normative values for overjet in infants below 12 months of age.

Dentofacial Orthopedics for the Cleft Patient: The Latham Approach.

Presurgical infant dentofacial orthopedic treatment (PSIOT) is a process by which cleft maxillary and soft tissue segments can be moved before surgical repair of lip. One of the PSIOT approaches used is the fixed PSIOT using Latham appliances. In this article, the authors provide an overview of this approach and the step-by-step process of placing these appliances intraorally. Prospective randomized clinical studies are necessary to definitively answer concerns surrounding the long-term effects of PSIOT.

A Paradigm Shift in the Management of Cherubism? A Preliminary Report Using Imatinib.

Cherubism is an autosomal-dominant inherited mutation in the SH3BP2 gene on chromosome 4p16.3. It is characterized by bilateral symmetric fibro-osseous lesions that are limited to the maxilla and mandible. The lesions present in early childhood and typically spontaneously involute after puberty. Current standard practice is to reserve surgery for symptomatic or severely disfiguring cases. This report presents 3 patients with cherubism who exhibited marked reduction in tumor size with imatinib, a tyrosine kinase inhibitor. Treatment was well tolerated, with few side effects.

Craniofacial fibrous dysplasia.

Despite recent advances in the understanding of the natural history and molecular abnormalities, many questions remain surrounding the progression and management of fibrous dysplasia (FD). In the absence of comorbidities, the expected behavior of craniofacial FD (CFD) is to be slow growing and without functional consequence. Understanding of the pathophysiologic mechanisms contributing to the various phenotypes of this condition, as well as the predictors of the different behaviors of FD lesions, must be improved. Long-term follow-up of patients with CFD is vital because spontaneous recovery is unlikely, and the course of disease can be unpredictable.

Strength analysis of 6 resorbable implant systems: does heating affect the stress-strain curve?

PURPOSE: The objective was to directly compare the strength of 6 different resorbable implant plating systems using an in vitro model before and after heating. MATERIALS AND METHODS: Red oak wood was cut and fixated using various resorbable plates and screws. Vertical load was applied and the specimens fractured, while a test machine gathered data. This was repeated after heating of the specimens. RESULTS: Several parameters were analyzed, and force versus displacement curves were plotted for each specimen. CONCLUSIONS: There were no statistically significant differences for total maximum loads between heat-treated and non heat-treated specimens. There were differences in strengths amongst the various systems.

Strength analysis of titanium and resorbable internal fixation in a mandibulotomy model.

PURPOSE: Mandibulotomy is used to access various tumors of the tongue base, posterior oral cavity, pharynx, parapharyngeal space, and cranial base. Internal fixation using titanium plates and screws is the most common method of stabilization. These have the potential for interference with radiotherapy delivery. This in vitro study compares the strength of titanium and resorbable internal fixation in a mandibulotomy model by analyzing the force required for plate and screw breakage. MATERIALS AND METHODS: Red oak wood board was used to simulate the mandible. Titanium and resorbable plates and screws in various configurations were used to stabilize pieces of the wood. They were arranged in 6 different groups. The specimens were individually tested with a vertical load, while the test machine recorded the force-versus-displacement behavior automatically. RESULTS: Plate type and configuration affected the applied load required to induce displacement of the simulated mandibulotomy. Heating and cooling the resorbable plates prior to strength testing also affected the load-versus-displacement curve. CONCLUSIONS: Overall, the titanium system we studied exhibited greater resistance to deformation from a vertical load than did the resorbable plate groups.

Cleft-orthognathic surgery.

For the cleft patient presenting in adolescence with a jaw discrepancy and malocclusion, misinformation and limited available surgical and dental expertise often prevents a favorable facial reconstruction and dental rehabilitation. A major advantage of the modified Le Fort I osteotomy is its ability to simultaneously close cleft dental gap(s), resolve oronasal fistulas, manage skeletal defects, stabilize dentoalveolar segments, and correct jaw deformities. When a thoughtful staging of reconstruction is undertaken, individuals born with cleft lip and palate can reach adolescence after undergoing only a limited number of operations and interventions, without negative attention being drawn to their original malformation.

Angioleiomyoma of the tongue.

A case of angioleiomyoma of the tongue is detailed. The patient sought treatment for a painless, rubbery mass of 10 years duration. The tumor was unusual, appearing bilobed, with the dorsal aspect whitish in color and a blue ventral component. Occasional episodes of numbness were noted. Biopsy of the lesion demonstrated bundles of smooth muscle cells surrounding numerous vascular spaces. The patient was lost to follow-up; as a result, a complete surgical excision of the tumor was not performed.

Nonsyndromic craniosynostosis: diagnosis and contemporary surgical management.

Contemporary surgical management of nonsyndromic craniosynostosis requires the combined expertise of a pediatric craniofacial surgeon and pediatric neurosurgeon. The goals of surgical intervention are the release of the affected suture, which allows for unrestricted development of the visceral components (eg, brain, eyes) and three-dimensional reconstruction of the skeletal components, which establishes a more normal anatomic position and contour. Surgeon who care for infants with these cranial and orbital malformations must maintain a thorough understanding of the three-dimensional anatomy, characteristic dysmorphology associated with the different types of synostosis, and the complex interplay that exists between surgical intervention and ongoing skeletal growth.