Caracterización de los pacientes con defectos bucomaxilofaciales atendidos en el Policlínico Universitario Julio Antonio Mella / Characterization of the patients with oral-maxillofacial defects attended in the University Polyclinic Julio Antonio Mella

Fundamento: las lesiones del macizo cráneofacial existen desde la evolución misma del hombre, lo que ha traído por consiguiente la necesidad de crear medios para enmascarar los defectos o restaurar el órgano perdido. Objetivo: caracterizar los pacientes con defectos bocomaxilofacial. Métodos: se realizó un estudio observacional, descriptivo y transversal desde enero del 2015 hasta mayo de 2018 en pacientes con defectos bucomaxilofaciales atendidos en el departamento de prótesis estomatológica del Policlínico Universitario Julio Antonio Mella de la Provincia Camagüey. El universo lo constituyeron 13 pacientes mayores de 20 años de edad de ambos sexos remitidos del Hospital Universitario Manuel Ascunce Domenech y Hospital Provincial Docente Oncológico María Curie.Resultados: respecto a los pacientes con defectos maxilofaciales rehabilitados según edad y sexo, fue más frecuente el sexo masculino y el grupo de 60 a 79 años. Según tipo y causa del defecto, fue superior el nasal y la oncológica con siete pacientes. Según tipo de defecto bucomaxilofacial y experiencia protésica, primó el defecto nasal, así como la experiencia protésica favorable en ocho pacientes. Conclusiones: los pacientes masculinos predominaron, junto con los mayores de 60 años. Los defectos bucomaxilofaciales más rehabilitados fueron los nasales y de origen oncológicos. Hubo un alto índice de experiencia favorable con el uso de las prótesis(AU)

Background: the injuries of the solid craniofacial exist from evolution of the man, which has brought therefore the need to create means to mask defects or to restore the lost organ. Objective: to characterize the patients with oral-maxillofacial defects.Methods: an observational, descriptive and transverse study was carried out from January, 2015 to May, 2018, in patients with oral-maxillofacial defects attended in the department dentistry prosthesis of the University Polyclinic Julio Antonio Mella of the city of Camagüey. The universe was constituted by 13 patients older than 20 years of age of both sexes cross-referred of the University Hospital Manuel Ascunce Domenech and Provincial University Oncological Hospital María Curie. Results: in relation to the patients with maxillofacial defects rehabilitated according to age and sex, prevailed the group 60 to 79 years, as well as the masculine sex. According to type and etiology of the defect, the nasal and the oncological was a superior with 7 patients respectively. According to type of defect oral-maxillofacial and prosthetic experience, the type of nasal defect had priority as well as the prosthetic favorable experience in 8 patients. Conclusions: the masculine patients predominated along with the older than 60 years old. The oral-maxillofacial defects most rehabilitated were the nasal and those of oncological causes. There was a tall index of favorable experience with the use of the prostheses (AU)

[How I explore a dento-maxillofacial dysmorphosis]. / Comment j'explore une dysmorphose dento-maxillo-faciale.

Dento-maxillofacial dysmorphoses represent a considerable area of maxillofacial surgery. Their incidence has constantly been on the rise since the beginning of the century. This can be explained by variations in the food and society habits.We will first discuss the various causes (congenital and environnemental) and the pathophysiology of these disorders. Then, we will separate them according to the skeletal and Angle's classifications. We will examine the predictive criteria of these dysmorphoses from the youngest age and consider their clinical and cephalometrical diagnosis. We will envisage their functional and aesthetic consequences and expose the preventive options. Finally, we will describe the orthodontic and surgical treatment available today and conclude that surgery remains the gold standard by restoring the conventional axis.

Les dysmorphoses dento-maxillo-faciales (DDM) occupent un volet important de la chirurgie maxillo-faciale. Elles constituent un problème en constante progression depuis le début du siècle, s'expliquant notamment par des modifications des habitudes alimentaires et sociétales (1). Nous discuterons les diverses causes, congénitales et environnementales, ainsi que les aspects physiopathologiques de ces affections et ferons le point sur leur classification grâce à la classe squelettique et la classe dentaire d'Angle. Nous discuterons des critères prédictifs de ces dysmorphoses dès le plus jeune âge ainsi que de leur diagnostic clinique et céphalométrique. Nous détaillerons leurs conséquences esthétiques et fonctionnelles et exposerons les mesures préventives visant à éviter leur développement. Enfin, nous évoquerons la thérapeutique à la fois orthodontique et chirurgicale que nous pouvons actuellement proposer pour restaurer les fonctions masticatoires, phonétiques et respiratoires tout en harmonisant le tiers inférieur de la face.

Clasificación de las alteraciones cefalogénicas desde una visión integradora craneomaxilofacial / Classification of cephalogenic alterations from a craneomaxilofacial integrative visión

Introducción: las clasificaciones sobre las alteraciones cefalogénicas presentan una gran dispersión debido a la multiplicidad de especialidades médicas que intervienen en la región de la cabeza. Objetivo: describir las clasificaciones más relevantes de las malformaciones craneofaciales y proponer una nueva clasificación. Métodos: se realizó un estudio mixto, hermenéutico y cuantitativo descriptivo, durante el cual se analizó la producción de clasificaciones sobre este tema en la Web of Sciences en el periodo comprendido desde 1992 hasta 2012. Luego de seleccionar 263 artículos que trataban este tema se estudiaron 22 de ellos en los que proponían clasificaciones o modificaciones al respecto. Se estudió la región anatómica, el tipo de clasificación, el tipo de malformación que describe y la revista de publicación. Resultados: hubo predominio del tipo de clasificación morfogénica en el 60 porciento, el tipo de malformación mayormente clasificada fue por defecto (fisuras e hipoplasias) en 72 por ciento y la revista con mayor representación de publicaciones sobre clasificaciones de alteraciones cefalogénicas fue TheJournal of Craniofacial Surgery donde se publicaron el 44 por ciento de ellas. Se propuso una clasificación integradora morfo-fisiopatológica y se analizó su validación interna y externa. Conclusiones: se demostró la ausencia de una clasificación que agrupara todas las malformaciones cefalogénicas, que incluyera a todas sus regiones anatómicas y tipos de malformaciones. La clasificación propuesta podría ser de utilidad para las especialidades médicas y estomatológicas afines a esta región anatómica(AU)

Introduction: classifications on cephalic alterations have great dispersion secondary to diversity of medical specialties involved in head region. Objective: to describe relevant classifications in craniofacial malformations and recommend a new classification. Method: was carried out a mixed study: hermeneutic and quantitative descriptive, to analyze the production of this kind of classifications on the Web of Sciences during the years 1992 to 2012. As result 263 papers was find on this topic and 22 papers were selected because provided classifications or modifications in this respect. This research analyzed the anatomical region, the classification type, the type of malformation and the magazine of publication. Results: there was a prevalence of the type of morphogenic classification in 60 percent, the mostly classified malformation type of by defect (fissures and hypoplasia) in 72 percent and the representative magazine of cephalic alterations classifications was the Journal of Craniofacial Surgery where 44 percent of them were published. An integrative morpho-physiopathologic classification was suggested and internal and external validation was analyzed. Conclusions: was demonstrated the absence of any classification that joined all the cephalic malformations of all the anatomical cephalic regions. The recommended classification would being of utility for medical and dentistry specialties related to this anatomical region(AU)

Tratamiento quirúrgico de malformaciones maxilofaciales clase III mediante cirugía ortognatica / Surgical correction of maxillofacial malformations with orthogmatic surgery

Las anomalías de posición y tamaño de los maxilares se presentan en ocasión de su diagnóstico con un caráter llamativo, pero también ambiguo; llamativo por su localización en la región facial y en ocasiones por las grandes proporciones de la anomalía, pero también ambiguo a la hora de concretar el diagnóstico y decidir una terapéutica. Saber cuándo se va a intervenir quirúrgicamente, en que zona del maxilar lo va a hacer, si en el maxilar superior o inferior, o en ambos a la vez. El objetivo del presente trabajo es identificar la importancia de un correcto diagnóstico y el trabajo interdisciplinario para la planificación quirúrgica para obtener los mejores resultados funcionales y estéticos mediante la presentación de un caso clínico par tal fin

Positional and size anomalies related to the maxillary and mandibular bones occasionally present as both visually impacting as well as ambiguous from a treatmente perspective. Impacting as they are located in the facial region and in occasion due to the magnitude of such, but also ambiguous when it comes to defining a correct diagnosis and deciding on a therapeutical action; knowing when to surgically intervene, which facial region to operate on, upper or lower jaw or both at a time. The objective of this article is to identify the importance of a correct diagnosis and interdiscipinary work reuired to conduct adequate surgical planning resulting on optimal functional and aesthetic results by presenting a clinical case to illustrate such procedure

Tratamiento quirúrgico de malformaciones maxilofaciales clase III mediante cirugía ortognatica / Surgical correction of maxillofacial malformations with orthogmatic surgery

Las anomalías de posición y tamaño de los maxilares se presentan en ocasión de su diagnóstico con un caráter llamativo, pero también ambiguo; llamativo por su localización en la región facial y en ocasiones por las grandes proporciones de la anomalía, pero también ambiguo a la hora de concretar el diagnóstico y decidir una terapéutica. Saber cuándo se va a intervenir quirúrgicamente, en que zona del maxilar lo va a hacer, si en el maxilar superior o inferior, o en ambos a la vez. El objetivo del presente trabajo es identificar la importancia de un correcto diagnóstico y el trabajo interdisciplinario para la planificación quirúrgica para obtener los mejores resultados funcionales y estéticos mediante la presentación de un caso clínico par tal fin(AU)

Positional and size anomalies related to the maxillary and mandibular bones occasionally present as both visually impacting as well as ambiguous from a treatmente perspective. Impacting as they are located in the facial region and in occasion due to the magnitude of such, but also ambiguous when it comes to defining a correct diagnosis and deciding on a therapeutical action; knowing when to surgically intervene, which facial region to operate on, upper or lower jaw or both at a time. The objective of this article is to identify the importance of a correct diagnosis and interdiscipinary work reuired to conduct adequate surgical planning resulting on optimal functional and aesthetic results by presenting a clinical case to illustrate such procedure(AU)

New classification scheme of proboscis lateralis based on a review of 50 cases.

BACKGROUND: Among congenital nasal deformities, proboscis lateralis is one of the rarest. Boo-Chai classified proboscis lateralis into four groups. Recently, we encountered a new case of proboscis lateralis with median cleft lip. We noticed that this classification had not been considered according to convalescence and embryologics, and further refinement seemed to be needed. METHODS: We reviewed all cases of proboscis lateralis reported in English through 2009 and classified them by intercanthal distance. RESULTS: A total of 34 studies involving 50 cases were reviewed. Six cases were identified as having normal intercanthal distance. Three of them presented nose abnormalities and fit Boo-Chai group II category. The other three were consistent with group I. Hypertelorism was observed in 27 cases and was further divided into two groups based on the occurrence of a frontal encephalocele. Seventeen cases without a frontal encephalocele were compatible with Boo-Chai groups III and IV. The other 10 cases associated with a visible encephalocele had encephalopathy; most died at an early age, and long-term survival cases suffered developmental delay and mental retardation. Seventeen cases were defined as hypotelorism, and all cases also presented as holoprosencephaly. CONCLUSIONS: The redefined classification contains two new groups: group V as hypertelorism with encephalocele and group VI as hypotelorism. A new classification scheme is proposed as not only convenient for clinical application but also embryologically accurate.

A classification and construction of congenital lateral facial clefts.

BACKGROUND: The repair of the lateral or transverse facial cleft is a surgical challenge on the account of the abnormal positioning and appearance of the cleft. MATERIALS AND METHODS: Over a twenty-seven year period, 22 lateral facial cleft cases were evaluated at a cleft lip (CL) and palate clinic and seven children underwent reconstruction of the lateral CL. RESULTS: Twenty-two of 3187 (0.69%) cases presented with a lateral CL. Five of these 22 cases (23%) had a bilateral, eight (36%) had a right-sided and nine (41%) had a left-sided cleft. The evaluation of these cases resulted in a new classification (namely an extension of the Tessier 7 cleft) classification for the cutaneous and muscle involvement: a superior (T7.1), middle (T7.2), inferior (T7.3) and agenetic (T7.4) lateral CL. The altered surgical construction: an internal mucosal straight-line closure, a curved cutaneous-mucosal red-lip/vermilion-lined flap for the lip commissure, muscle reconstruction at the modiolus and a positional cutaneous z-plasty for the rare lateral cutaneous cleft. CONCLUSION: The paper introduced a new classification for the lateral CL, as well as an altered surgical reconstructive technique for the most natural functioning of the lateral part of the face.

Oral-nasal-ocular cleft: the greatest challenge among the rare clefts.

INTRODUCTION: Number 3 cleft or oral-nasal-ocular cleft is a well-known entity that was described by Morian over a century ago. This malformation is a paranasal-medial orbitomaxillary cleft running across the lacrimal segment of the lower eyelid and over the lacrimal groove. The Tessier number 3 naso-ocular cleft represents one of the most difficult and challenging malformations to correct for the reconstructive surgeon. We have conducted a retrospective analysis of our series consisting of 21 cases. OBJECTIVE: The objective was to review the functional outcome and aesthetic results of the different techniques applied for each case. MATERIALS AND METHODS: From 1997 to 2007, 21 patients with a Tessier number 3 cleft were treated in our craniofacial units. The clinical findings, tomographic studies, and surgical procedures were reviewed and analyzed. We have discussed our protocol of the treatment. RESULTS: We have treated facial malformation in 2 craniofacial centers. Fourteen patients were evaluated in the first year of their life, with an average age at presentation of 3 years. Twelve patients were female, and 9 were male; 6 patients had amniotic bands in limbs, 5 patients had an association with Tessier number 11 cleft, 3 patients with number 9 cleft, and 1 with number 7 cleft. Related to cleft lip, 10 patients had bilateral cleft lip, and 8 patients had unilateral cleft lip. Three patients did not have any involvement of the upper lip. The alar base was deviated upward in 19 patients, 11 cases had severe anatomic alteration with the lateral border of the ala above the medial canthus, and 8 cases had a mild dislocation. Nine cases of lacrimal duct obstruction and 8 cases of lacrimal duct extrophy were identified. Twelve patients had a lower eyelid coloboma of varying grades, and there were 2 cases of microblepharia. Aiming the soft tissue reconstruction, eyelid, nose, and upper lip were evaluated regarding their position, absence of tissue, and position of medial canthus and ala. Twelve of our patients underwent correction in the same moment, their medial canthus rotated upward and the ala downward, using the contralateral side as the reference. The lip was treated using a Millard-like technique. Neo-conjunctivorhinostomy was performed in the same moment in 2 patients or later in 1 case. Four patients had plagiocephaly due to the cranial involvement, and they were submitted to cranioplasty. Three had neurosurgical approach and advancement of the frontal bandeau. One adult patient received an acrylic plate to reshape the frontal area. CONCLUSIONS: Tessier number 3 cleft is one of the most difficult and challenging malformations to correct for the reconstructive surgeon. Besides the difficulties of its treatment, patients with Tessier number 3 cleft may achieve good results when the team has good skills.

Management of facial asymmetry.

Asymmetries of the craniofacial region encompass a multitude of diverse and potentially complex abnormalities that may be the result of numerous causes. The expression and degree of asymmetry for a given condition, although a highly variable process, is the ultimate determinant of the nature of its treatment. This article highlights some of the key features and treatment strategies for various common facial asymmetries.

[From anomalies to abnormalities. Therapeutic considerations]. / De l'anomalie à la malformation. Réflexion et attitude thérapeutique.

The proper timing prior to any treatment should be the therapeutic decision. This concept seems to us particularly opportune as we deal, in the exercise of our disciplines, with facial morphology, a topic that is nowadays affected by excessive expectations and by the dictates of fashion, body image and appearance, all stirred up to a fever pitch by the media.

Tessier 3 cleft with clinical anophthalmia: two case reports and a review of the literature.

Tessier 3 cleft with clinical anophthalmia is one of the rarest craniofacial clefts, and hence little has been published about its management and treatment. This article presents two cases of Tessier 3 cleft with clinical anophthalmia. A review of the literature helps to diagnose these complex facial deformities. The treatment and etiopathogenesis are discussed.

Haemangiomas and vascular malformations of the maxillofacial region--a review.

Congenital vascular anomalies have been and remain poorly understood. Since 1982 haemangiomas and vascular malformations have been recognised as distinct entities that exhibit unique characteristics and demand appropriately tailored treatment plans. However, "haemangioma" still continues to be used as a clinical and pathological description of many different types of vascular anomalies, which complicates both the care of patients and the interpretation of reports in journals. In this review we summarise the current classification, terminology, and the pathological basis of these lesions and discuss their management. The various therapeutic options available and their outcome will be discussed in addition to the recent advances in the psychosocial aspects of care, interventional radiology, laser and pharmacological therapy.

[Incidence of dentofacial deformities in the Specialty Hospital of the Instituto Mexicano del Seguro Social]. / Incidencia de deformidades dentofaciales en un Hospital de Especialidades.

OBJECTIVE: To report the incidence and classification of dentofacial deformities from the Maxillofacial Department at the Specialty Hospital at the 21st Century National Medical Center of the Mexican Institute of Social Security in Mexico City. A descriptive, retrospective and transversal study was carried out. MATERIAL AND METHODS: Clinical files from 120 patients were reviewed from May 1997 to May 1998 with the purpose of classifying and determining the types of maxillofacial deformities and also to report whether these deformities were corrected by orthognatic surgery. RESULTS: One hundred twenty clinical files were reviewed and dentofacial deformities were found in 47 (39%). All patients were treated with orthognatic surgery. Surgical treatment was often combined (orthodontia and surgery). CONCLUSIONS: Regardless of the type of dentofacial deformities, an individualized treatment protocol must be designed for each patient. It is important to list the priorities and needs of the patients in order to find appropriate solutions, in regard to their importance.

Spectrum of dentofacial deformities: a retrospective survey.

INTRODUCTION: This retrospective study investigates the spectrum of dentofacial deformities, demographic profile, management and surgical outcomes of orthognathic patients treated in the University Hospital in Malaysia. MATERIALS AND METHODS: Over a period of 10 years (1989 to 1999), 34 patients with dentofacial deformities who had orthognathic surgery were reviewed; patients with cleft lip and palate or syndromes were excluded. RESULTS: The mean age (range, 17 to 35 years) of the patients was 24.3 years and the ratio of female to male was 2.4:1. The predominant ethnic group was Chinese, with females (47.1%) forming the largest group. The main reason for seeking surgery was aesthetic improvement (41%). The majority of the patients had skeletal class III pattern (91%) and bilateral sagittal split osteotomy was the most common surgery done (82%). Postoperative complications were mainly paraesthesia/numbness (56%) and infection (15%). In long-term review, 2 (6%) patients had persistent numbness of the inferior alveolar nerve. CONCLUSION: The findings suggest that the majority of the patients are young adult female students with skeletal class III pattern and treated for mandibular prognathism. The complication of persistent numbness and higher rate of postoperative infection indicate that longterm reviews and good antibiotic prophylaxis/therapy are necessary.

Abnormal anterior belly of the digastric muscle: a proposal for the classification of abnormalities.

We recognized an abnormal anterior belly of the digastric muscle in an 83-year-old male cadaver. Three muscle bundles were observed on the left anterior belly: (i) attached to the left digastric fossa; (ii) attached to the right digastric fossa; and (ii) attached to the raphe of the mylohyoid muscle. Four muscle bundles were recognized on the right anterior belly: (i) attached to raphe of the mylohyoid muscle; (ii, iii) attached to the exterior surface on the base of the mandible from the raphe of the mylohyoid muscle; and (iv) attached to the interior surface on the base of the mandible from the raphe of the mylohyoid muscle. The raphe of the mylohyoid muscle was curved significantly to right and the four abnormal bundles found on the right anterior belly (see above) were attached to its curved point.

Benign fibro-osseous diseases of the maxillofacial bones. A review and differential diagnosis.

Benign fibro-osseous lesions (BFOLs) of the maxillofacial bones represent a diverse group of pathologic conditions that includes developmental lesions, reactive or dysplastic diseases, and neoplasms. Owing to substantial overlap of the histopathologic findings, subclassification of BFOLs may be problematic. Moreover, this is not merely an academic exercise because the therapeutic management of BFOLs varies depending on the actual disease process. To further complicate matters, a number of other disease processes demonstrate clinical, radiographic, and microscopic features that bear resemblance to those encountered in recognized fibro-osseous conditions. The objective of this article is to review the most current clinicopathologic, radiographic, and molecular studies of BFOLs to aid the surgical pathologist in the recognition and diagnosis of this diverse group of maxillofacial lesions. A discussion of the various disease processes that occasionally may be confused with BFOLs also is included.

Classifying vertical facial deformity using supervised and unsupervised learning.

OBJECTIVES: To evaluate the potential for machine learning techniques to identify objective criteria for classifying vertical facial deformity. METHODS: 19 parameters were determined from 131 lateral skull radiographs. Classifications were induced from raw data with simple visualisation, C5.0 and Kohonen feature maps; and using a Point Distribution Model (PDM) of shape templates comprising points taken from digitised radiographs. RESULTS: The induced decision trees enable a direct comparison of clinicians' idiosyncrasies in classification. Unsupervised algorithms induce models that are potentially more objective, but their blackbox nature makes them unsuitable for clinical application. The PDM methodology gives dramatic visualisations of two modes separating horizontal and vertical facial growth. Kohonen feature maps favour one clinician and PDM the other. Clinical response suggests that while Clinician 1 places greater weight on 5 of 6 parameters, Clinician 2 relies on more parameters that capture facial shape. CONCLUSIONS: While machine learning and statistical analyses classify subjects for vertical facial height, they have limited application in their present form. The supervised learning algorithm C5.0 is effective for generating rules for individual clinicians but its inherent bias invalidates its use for objective classification of facial form for research purposes. On the other hand, promising results from unsupervised strategies (especially the PDM) suggest a potential use for objective classification and further identification and analysis of ambiguous cases. At present, such methodologies may be unsuitable for clinical application because of the invisibility of their underlying processes. Further study is required with additional patient data and a wider group of clinicians.

[Van Buchem disease. Maxillofacial changes, diagnostic classification and general principles of treatment]. / Malattia di Van Buchem. Alterazioni maxillo facciali, inquadramento diagnostico e principi generali di trattamento chirurgico.

Van Buchem's disease is a rare pathology with recessive transmission and variable expressivity characterised by a progressive cortical bone deposition. There are two types of this disease: Type I (Van Buchem's disease) progressive form for all life and with high level of PA (alkaline phosphate); Type II (Worth disease) the pathologic bone deposition stops at 20 years of age and the level of PA in the adult is normal. The most important histological feature is the bone hypertrophy with preservation of the lamellar frame. The bones interested are: skull vault, mandible, ribs, clavicle and diaphyseal portion of long bones. The first clinical manifestation became evident in childhood with progressive course. The narrowing of the cranial foramen is responsible of the progressive cranial nerves compression and the subsequent neurological signs. The disease is incurable; surgical treatment aims to reduce the intracranial pressure and to correct bones deformity. A clinical case in which the patient treated has esthetic problems but not neurological signs is presented.