Orthodontic and surgical treatment of facial asymmetry in a patient with unicoronal craniosynostosis.
正畸和手术治疗 1 例单冠性颅缝早闭患者面部不对称。
- 作者列表："Wu T","Reese P","Lee JC","Kerayechian N","Martz M","Solem RC
:This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.
: 本病例报告介绍了一名面部不同层次不对称患者的独特治疗方法。患者男，17 岁，诊断为右侧单侧冠状面滑膜病。他在融合侧有额部和眶上退缩，对侧有指挥。他面部的中部和下部向非融合侧旋转。这种独特的诊断对外科和正畸矫正提出了特殊的挑战。治疗方法，包括Le Fort I和II截骨、双侧矢状劈开截骨术和 4 颗前磨牙拔除的正畸治疗相结合，能够同时矫正鼻、面中部、下面部，和牙齿不对称。正畸医生和外科医生整合了他们在所有 3 个空间平面上矫正牙颌面不对称的努力。面部美观和牙齿功能显著改善，2 年保留期内无明显复发。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.