Cone-beam volumetric imaging in craniofacial medicine.

With the development of X-ray computed tomography (CT) in the 1960s and its first use for clinical studies in 1972 by Sir Godfrey Hounsfield, radiological tomography attained widespread use and today is one of the essential imaging techniques in medical radiology. It is a technically mature and clinically widely accepted method and complements classical X-ray panoramic radiography in many areas. The technology is frequently used in craniofacial radiology, because of its characteristic low radiation dose, high spatial resolution and lower cost compared with CT. The aim of this work was to describe the principles of cone beam computed tomography, to make a brief description of the existing devices, to present briefly the use of 3D diagnosis in craniofacial medicine.

The "Anatomical Balance Correction" for Secondary Cleft Lip Nasal Deformities.

Secondary cleft lip nasal deformities corrective procedures are still a major concern for the maxillofacial surgeons.

Eagle syndrome surgical treatment with piezosurgery.

INTRODUCTION: Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. MATERIALS AND METHODS: We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. RESULTS: No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. CONCLUSIONS: The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

A rare case of canine anomaly - a possible algorithm for treating it.

Canine transmigration is a very rare dental anomaly in which an unerupted mandibular canine migrates, crossing the mandibular midline. This unusual condition is most often diagnosed by chance during a routine X-ray examination. The most common clinical signs announcing the presence of this anomaly are over-retention of the deciduous canine and the absence of permanent canine from the dental arch after its physiological period of eruption. In this paper, we present a clinical case, 10-year-old boy, who was diagnosed with mandibular right canine transmigration at three years after the start of orthodontic treatment, during which we were expecting the eruption of mandibular canines. The orthopantomograph revealed the mandibular right canine to be in a horizontal position under the apices of the incisors - type 2 transmigration pattern classified by Mupparapu (2002). Based on cone-beam computer tomography examination, we recommended a surgical exposure of the canine and orthodontic alignment. Due to the risk of root resorption of the mandibular right lateral incisor during orthodontic movement phase of canine transmigrated to the dental arch, we decided to align the mandibular right canine in a transposition, between the two mandibular right incisors. Then we resorted to adapting the mandibular right lateral incisor coronary morphology to simulate a canine and also to reshaping the canine coronary morphology to resemble a lateral incisor. This therapeutic approach allowed us to restore morphologically and functionally the mandibular dento-alveolar arch, preserving the entire dental system.

Modifications of the marginal paradentium to a case of Angle Class III/1 malocclusion.

Angle Class III malocclusions are not so frequently met but they raise big problems of treatment. The analyzed case represents a 14-year-old patient that came to the dental consulting room with an Angle Class III malocclusion determined by the excess of the somatotropic pituitary hormone and a gingival hyperplasia more emphasized at the level of inferior frontal teeth. The patient followed a fixed appliance treatment, the straight-wire technique. All along the treatment and after it, the hyperplasia and the gingival inflammation not only maintained but they even got worse. Thus, an improper hygiene associated with a severe Angle Class III malocclusion maintains and aggravates the gingivitis. The histological and immunohistochemical study of the gingiva revealed important epithelial modifications that led to an epithelial hypertrophy with a tendency toward acanthosis and to severe epithelial erosions. An inflammatory chronic process (rich in lymphocytes, plasma cells and macrophages full of angiogenesis vessels) and an intense reaction of the fibroblastic cells appeared in the gingival corium.

Cranial sutures and diploae morphology.

The aim of the study was to assess the normal cranial suture and bone diploae ultrastructural morphology. Two types of sutures from different specimens were collected. The micro-CT scanning provided a three-dimensional view of the sutures at a microscopic level thus allowing the evaluation of the development stage and a rapid analysis evaluation of bone and diploae morphology. In the meantime, the micro-CT is able to generate more slices than the normal histology preserving the analyzed specimens and became one of the most powerful tools in the craniofacial area. The micro-CT analysis generated structure-orientated slices that in conjunction with the histological sections provide a high quality quantitative analysis of all cranial sutures and of the cranial bones diploae.

Three-dimensional cranial suture morphology analysis.

The aim of the study was to assess the normal and synostosed coronal cranial sutures morphology at an ultrastructural level. Different operative specimens of human coronal sutures were collected. Three-dimensional reconstruction of the microcomputed tomography (micro-CT) slices were obtained and compared with the representative histologic sections. The micro-CT scanning provides a three-dimensional view of the sutures at a microscopical level thus allowing to establish the stage of development and the bone morphology. The micro-CT has the advantage of being able to image more slices than the normal histology without any damage to the analyzed specimens. Micro-CT is a powerful tool in the craniofacial area that allows us to obtain many structure-orientated slices and in conjunction with the histologic sections provides an overall thorough quantitative analysis of all cranial sutures.

Correlations between the changes in patients' dental-facial morphology at the end of the orthodontic treatment and the psychological variables.

The purpose of this research was to assess the impact that the improvement of patients' dental-facial morphology has at the end of the orthodontic treatment upon the following psychological variables: self-esteem, current self-related thoughts as well as upon the variables of social self-esteem and performance. The number of patients included in the study was of 168 (82 children and 86 adolescents) who carried out the orthodontic treatment. At the end of the active treatment, we applied to all patients the assessment instruments for the level of self- esteem and self-related current thoughts: the Rosenberg's Self-Esteem Scale and the Heatherton & Polivy Current Thoughts Scale. As far as the patients in the study are concerned, the improvement of their facial aspect at the end of the treatment showed a significantly positive correlation with the variables of global self-esteem, self-related current thoughts, social self-esteem and performance, with the exception of the girls in children study group who showed no correlations between physical aspect and the performance variable.

Dental white spots associated with gastro-esophageal reflux in orthodontic and orthognathic surgery patients.

Gastro-esophageal reflux is a gastrointestinal disorder that might cause irreversible damages to the hard tissues of the teeth. The aim of this article is to report two cases of patients with severe dental demineralization associated with gastro-esophageal reflux during orthodontic and combined orthodontic-orthognathic surgery treatment. Diagnosis and prevention aspects are highlighted and discussed.

[New morpho-functional rehabilitation methods in cleft lip and palate]. / Noi metode de reabilitare morfo-functionala în despicaturile labio-maxilo-palatine.

UNLABELLED: The interdisciplinary, complex therapeutic protocol of the cleft lip and palate patients, applied in the Clinic of Cranio-Maxillo-Facial Surgery of "I. Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, involves the morphologic reconstruction as well as the functional rehabilitation. Functional rehabilitation is the aspect, which gives the esthetics, social and familial integration of the patient, offering good quality of life. METHOD: In the current study, a new method and concept of improving the phonetic function in the primary and secondary surgical steps, with the effect on muscle and bone, is presented. The new surgical techniques used comprise of the surgery of the levator veli palatini using the method designed by Sader, and bone distraction, during the same surgical procedure. The assessment of the phonetic results was performed using the NARSOM test. RESULTS: Following up the results of the techniques mentioned above, we consider that they improve extremely well the morphological status, while giving a functional and physiological support to the patient. CONCLUSION: Thus, they offer optimal conditions for the future progress of functional rehabilitation using specific speech therapy methods.

[A combined surgical-orthodontic approach of a class II/1 malocclusion. A case report]. / Tratamentul combinat chirurgical-ortodontic la un pacient cu o anomalie Angle clasa II/1. Prezentare de caz.

This case report highlights the possibility of a non extraction orthodontic treatment, surgically assisted, in a Class II Division 1 malocclusions in order to reduce maxillary protrusion prior to the surgical advancement of the mandible for the correction of the skeletal deficiency. The combined orthodontic-surgical approach optimizes the profile while allowing the settling of a Angle Class I occlusion at the end of the entire treatment sequence.