Orthodontic and surgical treatment of a patient with Apert syndrome.

The aim of this case report was to present the combined orthodontic and surgical treatment of a patient with Apert syndrome in an adult stage. A 15 years old male patient with Apert syndrome was concerned about the appearance of his face and malocclusion. His profile was concave with a retruded maxilla and prominent lower lip. He had an Angle class I molar relationship with a 9.5 mm anterior open bite. The amount of crowding was 20.4 mm in the maxilla and 6 mm in the mandible. Cephalometric analysis revealed a skeletal Class III relationship due to maxillary hypoplasia with a dolichofacial growth pattern. Orthodontic treatment and orthognathic surgery were planned for the patient. After 45 months of presurgical orthodontics, the patient underwent two surgeries sequentially. The first surgery was performed to advance the maxilla and the second surgery was performed to correct the mandibular rotation and increase the overbite at the time of removing halo device. The amount of maxillary advencement was 8 mm. Mandibula was moved 1.5 mm anteriorly and rotated 1° to 1.5° (SNB and facial depth) in a counterclockwise direction. After a relatively long treatment, an esthetically pleasing and functional occlusion and correction of the skeletal problem was achieved in this adult case.

Management of serious isolated gingival synechia in a newborn: case report and review of the literature.

Congenital synechia of the gums is a rare malformation. The fusion may be partial or complete and may be associated with other facial dysmorphologic malformations. The synechia can be fibrous or bony and may develop between the upper and lower alveolar ridges. The authors report a newborn with partial, but broad and continuous, synechia of the gums and discuss its management during the first days of life.

Bilateral congenital pits of the upper lip.

Congenital sinuses, fistulas, dimples, or pits of the lips are uncommon congenital malformations. In the upper lip they are extremely rare, and only one third of them are placed laterally. The authors present a patient with bilaterally placed upper lip pits associated with speech disorders, a short and everted upper lip with an orbicularis muscle defect in the midline, slight hypertelorism, and low-set ears. Orbicularis muscle repair and tubercle augmentation were performed. No further treatment was administered to the upper lip pits because of lack of symptoms. This is the third bilateral case of the sinus or pit of the upper lip reported in the literature.

Evaluation of velopharyngeal insufficiency with magnetic resonance imaging and nasoendoscopy.

Several radiological methods have been utilized to assess velopharyngeal function. The more recent imaging technique, magnetic resonance imaging (MRI), which has a number of advantages over radiographic and computed tomographic imaging, has been used rarely for evaluating velopharyngeal insufficiency. In this study, 5 normal volunteers and 10 patients with surgically repaired cleft palate were examined with MRI using midsagittal, coronal, and axial images. Nasoendoscopy was also performed to complete and confirm the diagnoses. Complete and tight closure of the velopharynx and full backward and upward movement of the soft palate was observed in volunteers. In coronal images, medial movement of lateral pharyngeal walls could also be seen. Despite this, patients with surgically repaired cleft palate had some degree of motion of the soft palate, ranging from no movement to maximal movement. In most of the patients, short soft palates with restricted motion was seen. MRI visualizes the velopharyngeal sphincter in all planes and provides high-resolution images of the soft tissues. Objective measurements can be made as well. In this study, MRI and nasoendoscopy were used together in the diagnosis of velopharyngeal insufficiency and gave satisfactory results.