Studies on the hypotensive and bradycardic effects of 1-piperidinylmethyl-2-naphthol hydrochloride

An understanding of growth and development and the effect our appliances have on a person's growth and development is necessary in the selection of the therapeutic appliances we choose to use, out of the multitude available. Timing of treatment is also important in effecting positive changes in skeletal and dental relationships. Early treatment to correct skeletal discrepancies and gain arch length can allow for an increase in nonextraction therapy. Cervical extraoral appliances, maxillary fixed expansion appliances, and mandibular labial "E" arches can be used early to effectively reduce of skeletal discrepancies and to gain arch length without the fear of rotating the mandible down and back, permanently increasing the mandibular plane angle. Case reports are presented to illustrate the beneficial changes that can occur with early treatment with these appliances.     

The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus

A study was made to determine whether skeletal alterations usually produced by rapid maxillary expansion may be compensated for in time by growth and/or comprehensive orthodontic treatment. In 30 patients, orthodontic treatment was started with rapid maxillary expansion, followed by fixed appliances, not combined with any other form of orthopedic device. Mean treatment time was 3.1 years. Nine measurements from the Ricketts analysis were studied, based on lateral cephalometric radiographs. Records were taken before orthodontic treatment and after completion of active therapy. A statistical analysis was made of the nine variables used, reflecting the vertical and anteroposterior skeletal proportions of the face, contrasting the changes before and after treatment. Of all the variables studied, the four that change with age according to the Ricketts analysis (mandibular plane angle, maxillary height, facial depth and facial convexity), yielded statistically significant differences after treatment, indicative of normal growth. The five remaining variables that remain constant with age according to the Ricketts analysis (facial axis, lower facial height, total facial height, palatal plane inclination and maxillary depth) showed no significant changes after treatment, also indicative of normal growth.     

Guiding occlusal development with functional appliances

Functional appliances have been used in orthodontics since their introduction by Pierre Robin almost one hundred years ago, however, our understanding of how they bring about orthodontic correction is still limited. This article is a brief overview of their history, mode of action, advantages and disadvantages, and includes the results of a study of attempts to control and minimise their side-effects using a recent development in functional appliances: the 'Teuscher Appliance'. This appliance combines a high-pull headgear with the activator, and is designed to reduce the often reported side-effects of functional appliances. The skeletal and dentoalveolar effects of treatment with the Teuscher Appliance on 40 consecutively-treated patients are reported and illustrated with four individual case reports. The results showed that the skeletal effect on the maxilla was a retardation of the normal forward and downward growth in 80 per cent of the cases, and that mandibular growth in 70 per cent of cases was forward. In patients whose mandibular growth was primarily in a vertical direction, such growth could be ascribed mainly to posterior rotation of the maxilla and/or the fact that the acrylic covering the lower posterior teeth to correct a deep bite was removed, promoting the eruption of these teeth and increasing the anterior vertical development. The dentoalveolar changes were characterised by retroclination of the maxillary incisors in 90 per cent of the patients, and were due to insufficient torque control by the built-in torque springs, which need further development. The mandibular incisors were well controlled by capping. The statistical analysis showed an inverse correlation between the initial incisor inclination and the change during treatment. This suggests that proclination of the lower incisors, as previously reported, is not a contra-indication to functional appliance treatment, provided the appliance is correctly designed. Overall, this study showed considerable individual response to treatment, and that the occlusal correction occurred through a combination of skeletal and dentoalveolar changes.     

Can frontal sinus development be used for the prediction of skeletal maturity at puberty?

The precision of a new procedure predicting skeletal maturity on the basis of frontal sinus development was tested in 59 boys with an Angle class-II division-1 malocclusion. Lateral head films were used for the analysis of frontal sinus development, and handwrist radiographs were used for the assessment of skeletal maturity. The results showed that skeletal maturity could be predicted with a certainty of about 85% when using a 1-year prediction interval and with a certainty of about 75% when using a 2-year prediction interval. In conclusion, the study showed that skeletal maturity can be predicted with rather high accuracy by means of the analysis of frontal sinus development as imaged on lateral headfilms.     

Modern imaging of craniofacial malformations

Due to progress in the field of medical imaging of craniofacial malformations, the place of these investigations in the assessment of these abnormalities needs to be revised. 3D CT scan currently remains the fundamental element of the assessment by providing a truly anatomical dissection of each bone. In the field of craniostenoses, the study of the base of the skull has allowed a new assessment of lesions of skull base and craniofacial sutures and the resulting skeletal deformities: they provide restrospective justification for an extensive approach to the surgery of this group of malformations and a basis for reflection concerning extension to direct skull base surgery. Craniofacial clefts constitute a heterogeneous groupe of anomalies in which Tessier's concepts have allowed a methodical approach. 3D CT allows better definition of certain subgroups of malformations within this group (midfacial clefts) and provides a clearer understanding of the skeletal defects of maxillary clefts, especially in the laterofacial region. This imaging is currently undergoing rapid development. Improvement of 3D CT scanning techniques (direct 3D image acquisition, improvement of the images obtained), development and combination of 3D MRI, after being superimposed onto the skeletal image, will allow total dissection of the malformation. Development of 3D cephalometric analysis techniques and growth analysis software will allow really predictive "image-assisted surgery". Finally, antenatal imaging (B-mode and 3D ultrasonography) makes a considerable contribution to this field of anomalies by allowing the diagnosis of serious or severely disabling anomalies and by elucidating the antenatal development of certain anomalies (especially craniostenoses) and their consequences.     

Reconstruction of composite facial defects: the combined application of multiple reconstructive modalities

OBJECTIVE: To describe the combined use of craniofacial skeletal reconstruction, tissue expansion and microvascular free tissue transfer in the repair of major composite facial defects. DESIGN: Case series with an integrated team approach. SETTING: Craniofacial unit, university teaching hospital. PATIENTS: Three cases were selected to best illustrate the combined use of the three modalities in reconstruction of acute traumatic, congenital and post-traumatic facial defects. A 15-year-old boy had a shotgun wound to the face; a 23-year-old man had Treacher Collins syndrome; and a 55-year-old woman had a post-traumatic composite defect of the central midface. INTERVENTIONS: Preoperatively, complete neurologic, ophthalmologic and dental examinations, anthropometric analysis, prosthodontic assessment, computed tomography and computer graphics. Operatively, craniofacial exposure followed established surgical principles. Skeletal reconstruction was performed to provide accurate positioning of bony segments and three-dimensional stability. Bone grafting was used when necessary to restore bony continuity and increase stability. Tissue expansion was used to provide more locally available tissue for wound closure and resurfacing composite defects. Microsurgical free tissue transfer was used to provide functional replacement of deficient tissues. RESULTS: The results of the modalities used for reconstruction of these composite facial defects are illustrated for each case described. CONCLUSIONS: The use of multiple modalities, including craniofacial skeletal reconstruction, tissue expansion and free tissue transfer, allow the surgeon to address the specific functional and anatomical requirements associated with composite facial defects that are characterized by a combined deficiency of multiple tissues in the craniofacial region.     

Ossification of the distal phalanx of the first digit as a maturity indicator for initiation of orthodontic treatment of Class III malocclusion in Japanese women

The influence of mandibular growth on the stability of orthodontic treatment has been well established. A particular problem is late mandibular growth in patients with Class III malocclusions, because of skeletal jaw discrepancies that may influence the timing and course of treatment, as well as the stability of posttreatment. We have used the ossification of the distal phalanx of the first digit as an indicator of the skeletal maturity of the patient and of their potential for further growth. Our previous studies have shown that fusion of the epiphysis and the diaphysis of the distal phalanx of the first digit occurs from 1 to 3 years after the pubertal growth maximum in Japanese women. In these case reports, the orthodontic treatment of two female patients with mild Class III skeletal malocclusions is presented to show the possible clinical application of the ossification of the first digit as an indicator of the completion or near cessation of mandibular growth in the timing of treatment of Class III malocclusions. The case reports show that, although both patients experienced some mild degree of mandibular growth after treatment, this method can be helpful in determining residual mandibular growth potential in Japanese female patients with Class III malocclusions and mild skeletal discrepancies.     

Effect of chlorphentermine on the lipids of rat lungs

The possibilities for radical craniofacial restructuring have increased dramatically in the past 6 years with the development of craniofacial surgery. The field developed from a background of patients with major craniofacial birth defects allowing orderly planning and expansion to correction of a multitude of other craniofacial structural problems. The procedures concentrate upon changing the skeletal structures using extensive subperiostial dissection of soft tissue, and adding bone to fill in areas of deficiency. There are three grades of complexity in craniofacial procedures. After extensive soft tissue sub-periostial stripping about the orbits and upper face, the simplest form consists of onlay bone grafts. The next most complicated involves osteotomies to shift the face into a more normal position. In its most complicated form, abnormal proportions of bone are removed and the orbits or cranium are shifted into a new or normal position. We have had experience with 69 patients since September, 1972. Thirty-six have had intracranial procedures. Infection has been the most serious problem, and there have been no instances of death or blindness. A number of lesser problems occur. Future applications of craniofacial surgery are appearing with great frequency as more experience is gained with its uses. It has particular application in acute and late reconstruction of patients with traumatic defects about the face. Preventive osteotomies are an area with great potential, by releasing stenotic areas of bone and allowing the developing brain to mold the upper face and orbits. There is also applicability in surgery of tumors about the craniofacial structure and in cosmetic surgery.     

A case of bilateral optic neuropathy and recurrent transverse myelopathy associated with perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)

The purpose of this study was to evaluate skeletal and dental effects of bionator headgear combination appliances on patients in development period with Class II, division 1 malocclusion. The comparison of computerized X-ray cephalometric measurements between the 26 treated children and 26 untreated children was made. The results showed that ANB angle was significantly reduced and horizontal mandibular growth development tended to be normal in the treated group. It was suggested that the bionator headgear combination appliance can restrain the maxillary growth early and promote the forward mandibular growth which contribute the functional jaws correction.     

Treatment of Class II, Division 2 in the late growth period

The "Deckbiss" with skeletal Class II jaw relationship sometimes presents a considerable therapeutic problem, particularly in the late growth period (DP3U), as regards the coordination of dental and skeletal treatment objectives. An effective treatment approach was demonstrated: a modified Herbst appliance used simultaneously with fixed appliances in the maxilla. The sample comprised 12 male (14.0 +/- 0.9 years old) and 10 female (12.3 +/- 0.4 years old) patients. Correction of the distal occlusion was achieved in all patients by means of the Herbst appliance, which was removed after an average time period of 6.4 +/- 0.2 months. In the mandible the multibracket appliances were then immediately inserted, and Class II elastics were used for retention. Maximum anchorage was required in the maxilla as well as in the mandible. Complete diagnostic records were made at the beginning of the treatment as well as 6 and 12 months later, in order to document skeletal and dental changes. A dental and skeletal Class I relationship was achieved in all cases. A significant improvement was recorded in the vertical jaw base relationship; this was still stable after a period of 12 months. In the dental area in particular, a so-called high-pull headgear effect (intrusion and distalization 16, 26) and intrusion of teeth 34, 44 were registered. Only a minor protrusion of the mandibular incisors was observed. Reinforcement of the bands reduced the failure rate significantly. The Herbst appliance does not represent a standard treatment for Class II. Its indication range is limited.     

Dynamics of morphometric parameters of skeletal bone in inhabitants of Saint-Petersburg

2102 roentgenograms of the left manus bones from both sexes subjects with normal health status aged up to 18 were studied to detect peculiarities of skeleton maturity of St. Petersburg inhabitants. TW-2 modified Tanner-Whitehouse method was used. It was demonstrated that children living in St. Petersburg are characterized with the excess of skeletal age over chronological one almost in all age groups, which is maximum typically during first years and minimum by the end of puberty. The process of bone maturity is not successive. Highest growth rate of skeletal maturity were found in prepubescent and puberty. Sex differences established are also noted. Girls were above boys in skeletal age at 7, 8, 9 and 10 years.     

Gene expression of trehalase during post-dormant development of the brine shrimp, Artemia: comparison of the two species

The purpose of this article is to summarize the short-term and long-term results of the authors' clinical prospective study on the treatment of Class III malocclusion using the protraction facemask. An attempt is made to answer questions pertaining to this treatment modality. Twenty patients with skeletal Class III malocclusion were treated consecutively with maxillary expansion and a protraction facemask. A positive overjet was obtained in all cases after 6 to 9 months of treatment. These changes were contributed to by a forward movement of the maxilla, backward and downward rotation of the mandible, proclination of the maxillary incisors, and retroclination of the mandibular incisors. The molar relationship was overcorrected to Class I or Class II dental arch relationship. The overbite was reduced with a significant increase in lower facial height. The treatment was found to be stable 2 years after removal of the appliances. At the end of the 4-year observation period, 15 of the 20 patients maintained a positive overjet or an end-to-end incisal relationship. Patients who reverted back to a negative overjet were found to have excess horizontal mandibular growth that was not compensated by proclination of the maxillary incisors. A review of the literature showed that maxillary expansion in conjunction with protraction produced greater forward movement of the maxilla. Maxillary protraction with a 30 degrees forward and downward force applied at the canine region produced an acceptable clinical response. The reciprocal force from maxillary protraction transmitted to the temporomandibular joint did not increase masticatory muscle pain or activity. Significant soft tissue profile change can be expected with maxillary protraction including straightening of the facial profile and better lip competence and posture. However, one should anticipate individual variations in treatment response and subsequent growth changes. Treatment with the protraction facemask is most effective in Class III patients with a retrusive maxilla and a hypodivergent growth pattern. Treatment initiated at the time of initial eruption of the upper central incisors helps to maintain the anterior occlusion after treatment.     

Investigation of protein folding by mass spectrometry

Bone repair by regeneration as we know it continues to undergo changes, with advances approaching that may change our treatment of patients with craniofacial deformities and skeletal defects. Perhaps by the turn of the century, patients born with asymmetric deformities due to lack of growth will be treated early in life by skeletal stretching, and then later in life by skeletal distraction that is followed by use of accelerating factors to assist the healing processes. All of these available modalities are part of the regeneration of new bone formation. The future of such changes is very interesting, and our ability to help our patients will be maximized. We may even look back 25 years from now at bone grafting and find it to be obsolete and crude. It is hoped that with the new modalities being developed, we will not deviate from the use of a bone grafting procedure, which is the workhorse of the craniofacial surgeon. Bone grafting is used by all surgeons working on the craniofacial skeleton despite the problems of unpredictability of healing and an inability to calculate what percentage of the original graft will survive. The transplantation issue will be solved. The problems with donor site morbidity will continue. The use of inorganic bone substitutes will continue to have its limitation, particularly in type II wounds, which we as plastic surgeons see in the craniofacial region. As we redefine our approach to skeletal repair, we may look back and find solutions to some of the major problems we have had. The rapid stretch of soft tissue after facial advancement or structural alteration that is accompanied by a relapse due to the elastic recoil of the soft tissue could be eliminated by gradual distraction. The bone will undergo better functional adaptation when it has a gradual change in structure based on adjustment and molding in a gradual fashion. The problem of donor site morbidity and a prediction formula for bone could be resolved with new bone formation in situ by mineralization of the area under repair. Bone healing enhancers are here to stay and their clinical application will produce a far-reaching better final outcome (Fig. 11).     

A modified, lingually supported cantilevered Herbst appliance

This new, fixed-functional appliance/Herbst/Bioprogressive system is designed for patient comfort and mandatory compliance. It also combines the positive clinical effects of four fixed-functional systems. It allows rapid palatal expansion of the upper arch, alveolar uprighting of the lower arch, upper and lower incisor alignment, and sagittal correction of Class II malocclusions to occur simultaneously with one appliance fixed in both arches. It is indicated for use in growing patients with skeletal Class II malocclusions. The ideal timing for treatment is the late mixed dentition. Being able to remove the appliance after one year with the upper second bicuspids erupting slightly Class III so the clinician can immediately begin fixed finishing mechanics would be ideal. This new Herbst design will reduce the frequency of orthognathic surgery and upper bicuspid extraction to camouflage Class II malocclusions. At the same time, it gives total control to the clinician in treating some more difficult, non-compliant patients. Fixed-functional appliances, which improve treatment efficiency and treatment results and provide for patient comfort, while at the same time give the treating clinician almost total control of the three planes of facial growth will open new doors for orthodontic treatment and research in the next century.     

Repression of hedgehog signaling and BMP4 expression in growth plate cartilage by fibroblast growth factor receptor 3

Fibroblast growth factor receptor 3 (FGFR3) is a key regulator of skeletal growth and activating mutations in Fgfr3 cause achondroplasia, the most common genetic form of dwarfism in humans. Little is known about the mechanism by which FGFR3 inhibits bone growth and how FGFR3 signaling interacts with other signaling pathways that regulate endochondral ossification. To understand these mechanisms, we targeted the expression of an activated FGFR3 to growth plate cartilage in mice using regulatory elements from the collagen II gene. As with humans carrying the achondroplasia mutation, the resulting transgenic mice are dwarfed, with axial, appendicular and craniofacial skeletal hypoplasia. We found that FGFR3 inhibited endochondral bone growth by markedly inhibiting chondrocyte proliferation and by slowing chondrocyte differentiation. Significantly, FGFR3 downregulated the Indian hedgehog (Ihh) signaling pathway and Bmp4 expression in both growth plate chondrocytes and in the perichondrium. Conversely, Bmp4 expression is upregulated in the perichondrium of Fgfr3-/- mice. These data support a model in which Fgfr3 is an upstream negative regulator of the hedgehog (Hh) signaling pathway. Additionally, Fgfr3 may coordinate the growth and differentiation of chondrocytes with the growth and differentiation of osteoprogenitor cells by simultaneously modulating Bmp4 and patched expression in both growth plate cartilage and in the perichondrium.     

The craniofacial dysostosis syndromes. Staging of reconstruction and management of secondary deformities

During the past several decades, since the introduction of craniofacial surgery by Dr. Tessier in 1967, craniomaxillofacial surgery has advanced in many ways. Craniosynostosis is a common craniofacial malformation and requires a thoughtful team approach to select the preferred timing and technical aspects of reconstruction. The current approach to the correction of the deformities associated with the craniofacial dysostosis syndromes is to stage the reconstruction to coincide with facial growth patterns, visceral function, and psychosocial development. Recognition of the need for a staged reconstructive approach serves to clarify the objectives of each phase of treatment both for the clinicians and family. By continuing to define our rationale for the timing, method, and extent of surgical intervention and then objectively evaluating both functional and morphologic outcomes, we will improve the outlook for patients affected by these disorders.     

Genetic profile of pNOB8 from Sulfolobus: the first conjugative plasmid from an archaeon

Recently, children born small for gestational age (SGA) with a catch-up growth failure, have been selected for high dose growth hormone (GH) treatment. In order to gain greater insight concerning dentofacial growth and maturation of these patients, and to evaluate the possible effects of high does GH administration on facial structures, craniofacial growth and dental maturation were evaluated in short SGA persons. Seventy-seven cephalograms and orthopantomograms were available from 48 subjects, aged between 2 and 32 years. Craniofacial growth was assessed by calculating age- and gender-specific standard deviation scores (SDS) for eight linear and five angular measurements. Tooth formation was evaluated by means of a dental delay score (i.e. dental age minus chronological age). The SDS for craniofacial growth measurements for the lateral aspect showed a short anterior cranial base (-1.8 SDS), a small retropositioned mandible (< or = -1.7 SDS) and a small maxilla (-1.5 SDS); a high mandibular plane angle (+1.9 SDS) and a wide cranial base angle (+1 SDS). These findings result in a small retrognathic face with a relatively increased lower anterior face height (+1.7 SDS). In contrast to skeletal maturation, dental age was not delayed. The general growth retardation is, apparently, reflected to a differential extent within the craniofacial complex, while dental maturation appears to be a distinct process tightly linked to chronological age, and independent of general growth and bone age.     

Primary surgery of skeletal dysgnathias

Three case studies from the patient population of the University Hospital of Aachen (RWTH) are used to describe indications for primary surgical intervention in skeletal dysgnathia. Such preconditions may apply in the case of mandibulo-alveolar protrusion, anomalies where there is little or no option to fixing orthodontic appliances (enamel hypoplasia or shortened crowns), severe transversal discrepancies and skeletal dysgnathia with pronounced malpositioning in the alveolar process and the teeth. The advantages are improved compliance (through the patient experiencing success at the outset of treatment) and limitation of postoperative orthodontic treatment to occlusive fine adjustments of the occlusion, resulting in an appreciable reduction in both the degree and duration of tooth movement and tissue damage.     

Log-linear allometry of fetal craniofacial growth in Down's syndrome

Trisomy 21 develops as a result of nondisjunction of two homologous chromosomes during either the first or second meiotic division. One of the more important consequences of these genetic alterations is the predictable, although variable disturbance in the architecture of the craniofacial region [1]. Postnatal craniofacial morphology has been extensively studied in Down's syndrome (DS). However, little information is available on human prenatal development of the head and face in such patients. The time at which changes in craniofacial phenotype first emerge in Down's syndrome fetuses and at which physical growth begins to diverge from normal is unknown. To explore these questions, we compared prenatal craniofacial growth in 50 Down's syndrome fetuses with that of 555 fetuses judged to be "typical for body weight and age" using the method of log-linear allometry [2].     

Maxillary distraction osteogenesis in Pfeiffer's syndrome: urgent ocular protection by gradual midfacial skeletal advancement

Distraction osteogenesis is increasingly recognised as a potentially useful technique to achieve the co-ordinated augmentation of craniofacial skeletal and soft tissue. A case is presented where bilateral maxillary distraction was successfully used to advance the midface in the treatment of recurrent ocular dislocation, in a 10-month-old boy with Pfeiffer's syndrome.