Search Results (20)

Background/Objectives: Port-wine stains (PWSs), also known as naevus flammeus or capillary malformations, are congenital cutaneous lesions, typically located in the head/neck area. The manifestations of PWSs include aesthetic and functional impairments due to soft and hard tissue modifications. Sturge–Weber syndrome is characterised by additional neuro-ocular manifestations. This systematic review aimed to identify and overview the orodental manifestations of PWSs. Methods: Several databases (PubMed, Web of Science, Scopus, Embase, Cochrane Library) were searched using keywords for PWSs and oral and dental manifestations. The results were centralised, deduplicated, and selected in a two-step sequence. Data were extracted using pre-defined extraction forms and represented graphically and tabulated. The Newcastle–Ottawa and Joanna Briggs Institute scales were used for quality assessment. Results: Out of 884 results, 43 studies were selected for inclusion. Eleven studies investigated patients diagnosed with PWSs, while thirty-two studies investigated SWS patients. Regarding study designs, eight studies were retrospective, one was cross-sectional, two were case series, and thirty-two were case reports. The most frequently mentioned manifestations were gingival hypertrophy, lip hypertrophy, mucosal or gingival staining, malocclusion, gingivitis or gingival bleeding, and facial asymmetry. Conclusions: Due to the rarity of this pathology, the orodental manifestations of PWSs are not widely known to dentists. Soft tissue hypertrophy, malocclusion, and bony hypertrophy are significant concerns that need to be addressed during treatment. Full article

Background: RT-qPCR is a powerful strategy for recognizing the most appropriate reference genes, which can successfully minimize experimental mistakes through accurate normalization. Ludisia discolor, recognized for its ornamental value, features little, distinctive blossoms with twisted lips and gynostemium showing chiral asymmetry, together with striking blood-red fallen leaves periodically marked with golden blood vessels. Methods and Results: To ensure the accuracy of qRT-PCR, selecting appropriate reference genes for quantifying target gene expression levels is essential. This study aims to identify stable reference genes during the development of L. discolor. In this study, the entire floral buds, including the lips and gynostemium from different development stages, were taken as materials. Based upon the transcriptome information of L. discolor, nine housekeeping genes, ACT, HIS, EF1-α1, EF1-α2, PP2A, UBQ1, UBQ2, UBQ3, and TUB, were selected in this research study as prospect interior referral genes. The expression of these nine genes were found by RT-qPCR and afterwards comprehensively examined by four software options: geNorm, NormFinder, BestKeeper, and ΔCt. The outcomes of the analysis showed that ACT was the most steady gene, which could be the most effective inner referral gene for the expression evaluation of flower advancement in L. discolor. Conclusions: The results of this study will contribute to the molecular biology research of flower development in L. discolor and closely related species. Full article

This case report presents a virtual treatment simulation of the orthodontic treatment and surgery-first orthognathic surgery employed to treat a patient with a repaired unilateral cleft lip and alveolus with Class III malocclusion and lower third facial asymmetry. The patient exhibited a negative overjet of 9 mm, a missing lower right second premolar, and a 5 mm gap between the upper right central and lateral incisors with midline discrepancy. The three-dimensional virtual planning began with virtual pre-surgical orthodontics, followed by the positioning of the facial bones and teeth in their ideal aesthetic and functional positions. The sequence of steps needed to achieve this outcome was then reverse-engineered and recorded using multiplatform Nemostudio software (Nemotec, Madrid, Spain), which facilitated both surgical and orthodontic planning. The treatment included a two-piece segmental maxillary osteotomy for dental space closure, a LeFort I maxillary advancement, and a mandibular setback with bilateral sagittal split osteotomy to correct the skeletal underbite and asymmetry. A novel approach was employed by pre-treating the patient for orthognathic surgeries at age 11, seven years prior to the surgery. This early phase of orthodontic treatment aligned the patient’s teeth and established the dental arch form. The positions of the teeth were maintained with retainers, eliminating the need for pre-surgical orthodontics later. This early phase of treatment significantly reduced the treatment time. The use of software to predict all the necessary steps for surgery and post-surgical orthodontic tooth movements made this approach possible. Multi-step virtual planning can be a powerful tool for analyzing complex craniofacial problems that require multidisciplinary care, such as cleft lip and/or palate. Full article

This case report describes an 18-year-old female patient with a skeletal class I pattern, mandibular asymmetry, a molar class III on the right side, a molar class II on the left side, and an anterior open bite (AOB). Treatment of AOB is often difficult for orthodontists and a multidisciplinary approach is sometimes required to rehabilitate the correct function and posture of the tongue. In this case the AOB was treated using the Nuvola^® OP System: a treatment system that combines orthodontic aligners and a myofunctional elastodontic device called Freedom. An upper molar intrusion with miniscrews was performed during the first phase of the treatment programme, and then the aligner treatment began. The Nuvola^® OP System ’s aligners are characterized by lingual pins that guide the tongue to the palatal spot position and take advantage of tongue function. The patient was instructed to wear the Freedom device for 30 min a day and to clench every 3 s with closed lips while wearing the aligners. These exercises improve the fitting of the aligners, improve the tongue’s posture, and take advantage of the masticatory forces to resolve the malocclusion. The patient was successfully treated, thus demonstrating that the Nuvola^® OP System is a valid alternative for the treatment of AOB. Full article

Facial asymmetry is common in unilateral clefts. Since virtual surgical planning (VSP) is becoming more common and automated segmentation is utilized more often, the position and asymmetry of the orbits can affect the design outcome. The aim of this study is to evaluate whether non-syndromic unilateral cleft lip and palate (UCLP) patients requiring orthognathic surgery have asymmetry of the bony orbits. Retrospectively, we analyzed the preoperative cone-beam computed tomography (CBCT) or computed tomography (CT) data of UCLP (n = 15) patients scheduled for a Le Fort 1 (n = 10) or bimaxillary osteotomy (n = 5) with VSP at the Cleft Palate and Craniofacial Center, Helsinki University Hospital. The width, height, and depth of the bony orbit and the distance between the sella turcica and infraorbital canal were measured. A volumetric analysis of the orbits was also performed. The measurements were tested for distribution, and the cleft side and the contralateral side were compared statistically with a two-sided paired t-test. To assess asymmetry in the non-cleft population, we performed the same measurements of skeletal class III patients undergoing orthognathic surgery at Päijät-Häme Central Hospital (n = 16). The volume of bony orbit was statistically significantly smaller (p = 0.014), the distance from the infraorbital canal to sella turcica was shorter (p = 0.019), and the anatomical location of the orbit was more medio-posterior on the cleft side than on the contralateral side. The non-cleft group showed no statistically significant asymmetry in any measurements. According to these preliminary results, UCLP patients undergoing orthognathic surgery show asymmetry of the bony orbit not seen in skeletal class III patients without a cleft. This should be considered in VSP for the correction of maxillary hypoplasia and facial asymmetry in patients with UCLP. Full article

The study aimed to assess central nervous systems in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD), using the techniques of magnetic resonance (MRI). The analyses considered 200 children, both female and male, aged 6–17 years, diagnosed with FASD, as well as 32 healthy children of both sexes, aged 6–16 years. Brain anomalies as well as linear and surface area measurements of the brain and corpus callosum were assessed. 1H MRS and DWI signals were evaluated in the frontal lobes, basal ganglia, hippocampi, and cerebellum. Several brain anomalies were found in children with FASD. Qualitative assessment showed the thinning of the corpus callosum in 40% of the cases and cerebral ventricular asymmetry in 32% of the children. The mean thickness of the corpus callosum isthmus and the mean length of the corpus callosum were statistically lower in children with FASD. Higher Lip/Cr concentration and DWI values as well as lower NAA/Cr, Cho/Cr, and mI/Cr concentrations were found in multiple studied brain regions. The analysis of the present findings in the study group showed that brain MRI examinations of children with FASD more often identified a decreased corpus callosum and 1H MRS and DWI abnormalities, particularly in the region of basal ganglia. Full article

Cleft lip and palate is the most common asymmetric congenital condition of the orofacial region, which also finds its reflection in dental anomalies. The aim of the study was to present the dental asymmetries of the front region of the maxilla in cleft patients. Materials and Methods: We analyzed plaster casts and panoramic X-rays of 154 patients with total clefts and 151 healthy individuals. The cleft patients’ age ranged between 7.1 and 20 years (mean 13.18). The control group had a similar age range (7.1 and 20 years, mean 13.44). The digital caliper was used to measure the width of the teeth. Each measurement was performed three times each. Results: Most of the dental anomalies among cleft patients referred to the lateral incisors and were focused on the cleft side. The asymmetry of the incisors is reflected both in the number of teeth in the cleft region and their width. The lateral incisor was missing twice as frequently on the cleft side of the individual. If present, the lateral incisor was usually ±1.5 mm narrower than the incisor on the opposite side. In bilateral clefts, dental anomalies occurred more frequently on the left side. Conclusions: Dental problems occurred more frequently in patients with total cleft lip and palate than in healthy individuals. The most commonly affected teeth were the lateral incisors. The width of the lateral incisors was reduced in cleft patients—showing a smaller mesiodistal dimension on the cleft side. Full article

Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords “facial rehabilitation”, “acne scars”, “traumatic scars”, “oral restoration”, “facial lipoatrophy”, “facial asymmetry”, “periocular correction”, “nasal obstruction”, “ear lobe restoration”, “morphea”, AND “hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence. Full article

Background: Understanding the stomatognathic system disturbances is key to diagnosing them early and implementing rehabilitation approaches to promote functional recovery. The objective of this study was to systematically review all published data that examined the assessment and rehabilitation strategies for the stomatognathic system disturbances in patients with stroke. Methods: Five databases (i.e., PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and PEDro), were screened for manuscripts that included the assessment and rehabilitation strategies for stomatognathic system disturbances. The methodological quality was evaluated using the Mixed Methods Appraisal Tool. Results: Sixteen articles were included in this systematic review. The most frequently reported symptoms in patients with stroke included stiffness and thickness of the masseter muscle on the affected side and suprahyoid muscles; facial muscles’ asymmetry and weakness; temporomandibular disorders; and a reduced maximum lip force, tongue pressure, and saliva flow rate. The rehabilitation strategies more frequently reported included exercises directed to the jaw, temporomandibular joint, tongue, and neck. The mean score for methodological quality was 85%. Conclusion: The stomatognathic system disturbances are frequently reported among patients with stroke, leading to dysfunction in masticatory performance or swallowing. More studies on interventions for stomatognathic system disturbances are required before conclusions may be drawn. Key Practitioner Message: This systematic review has clinical implications for rehabilitation practices, given that the results may help to develop early assessment and rehabilitation strategies for stomatognathic disturbances in patients with stroke. Full article

Facial paresis involves functional and aesthetic problems with altered and asymmetric movement patterns. Surgical procedures and physical therapy can effectively reanimate the muscles. From our database, 10 patients (18–50 years) suffering from unilateral segmental midface paresis and rehabilitated by a masseteric-to-facial nerve transfer combined with a cross-face facial nerve graft, followed by physical therapy, were retrospectively analyzed. Standardized labial movements were measured using an optoelectronic motion capture system. Maximum teeth clenching, spontaneous smiles, and lip protrusion (kiss movement) were detected before and after surgery (21 ± 13 months). Preoperatively, during the maximum smile, the paretic side moved less than the healthy one (23.2 vs. 28.7 mm; activation ratio 69%, asymmetry index 18%). Postoperatively, no differences in total mobility were found. The activity ratio and the asymmetry index differed significantly (without/with teeth clenching: ratio 65% vs. 92%, p = 0.016; asymmetry index 21% vs. 5%, p = 0.016). Postoperatively, the mobility of the spontaneous smiles significantly reduced (healthy side, 25.1 vs. 17.2 mm, p = 0.043; paretic side 16.8 vs. 12.2 mm, p = 0.043), without modifications of the activity ratio and asymmetry index. Postoperatively, the paretic side kiss movement was significantly reduced (27 vs. 19.9 mm, p = 0.028). Overall, the treatment contributed to balancing the displacements between the two sides of the face with more symmetric movements. Full article

Systemic sclerosis (SSc) is a heterogeneous, chronic connective tissue disease, characterized by skin fibrosis as well as vascular and visceral lesions. It can involve the lungs, heart, kidneys, gastrointestinal tract, and bones. The orofacial manifestations of SSc can cause functional, aesthetic, and social distress, resulting in significant psychological implications for the patients. In recent decades, fat grafting improved the aesthetic outcomes in terms of volume deficiency, contour asymmetry, and skin elasticity of the face thanks to the regenerative action of the stem cells contained within it. We describe five cases of a patient with SSc treated with fat grafting used to correct volume loss and facial elasticity of the lips and perioral region on the middle and lower third of the face. All the patients received regular postoperative checks at weeks 1 and 2. A multiple choice questionnaire was administered to assess the degree of tolerability of the procedure. The reliability of the questionnaire was evaluated by calculating the Cronbach alpha using the MedCalc Statistical Software version 20.113. The aim of our study is to describe three different types of fat grafting used to correct volume loss and restore facial elasticity of the lips and perioral region on the middle and lower third of the face. Full article

A facial scanner and three-dimensional computed tomography (CT) were used to evaluate the three-dimensional change in lip asymmetry before and after two-jaw surgery for 22 patients with facial asymmetry (menton deviation > 3 mm). We used the labrale superius (Ls), deviated/non-deviated-side cheilions (Ch-D/Ch-ND), and labrale inferius (Li) to construct the upper and lower lip planes to evaluate the lip asymmetry. A correlation analysis was performed to determine the factors related to the vertical change in the cheilions (ΔChZ-D/ND). In the transverse axis, Ch-D and Li moved to improve the asymmetry after surgery. All landmarks, except the Ls, moved backward in the anteroposterior axis. In the vertical axis, significant upward movement was observed in all hard tissue landmarks; however, there were no significant changes in the soft tissue. In the lip plane, the difference in the height of Ch-D and Ch-ND was significantly reduced (1.38 mm vs. 0.72 mm). In the anteroposterior axis, the ΔChZ-D/ND showed significant correlations with the mandibular setback. In the vertical axis, the ΔCh-ND showed significant correlations with the maxillary impaction of the non-deviated side. The improvement in lip asymmetry post-surgery was mainly achieved by the movement of the lower lip and Ch-D rather than the upper lip and Ch-ND. Full article

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance. Full article

Background: The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function. Mandibular asymmetry and respective condyle adaptation may be an etiological factor in temporomandibular disorder. This study aims to evaluate the effects of maxillary expansion on the position and angulation of the condyles as well as the intercondylar distance in children with cleft lip and palate. Methods: Twenty-five individuals with cleft lip and palate who underwent maxillary expansion were selected. Condylar changes were evaluated by cone beam computed tomography using the Pullinger and Hollender formula. To determine the statistically significant differences between the variables, the Student t-test and the Benjamini–Hochberg correction method for multiple comparisons were used. Results: No statistically significant differences between angulation and condylar position before and after maxillary expansion were found. The intercondylar distance tended to increase in growing individuals with cleft lip and palate after maxillary expansion. Conclusions: Intercondylar distance shows a tendency to increase after expansion regardless of the cleft phenotype. No differences were found in angulation and condylar position with the changes in occlusion resulting from maxillary expansion. Full article

Ciliopathies are genetic syndromes that link skeletal dysplasias to the dysfunction of primary cilia. Primary cilia are sensory organelles synthesized by intraflagellar transport (IFT)—A and B complexes, which traffic protein cargo along a microtubular core. We have reported that the deletion of the IFT-A gene, Thm2, together with a null allele of its paralog, Thm1, causes a small skeleton with a small mandible or micrognathia in juvenile mice. Using micro-computed tomography, here we quantify the craniofacial defects of Thm2^−/−; Thm1^aln/+ triple allele mutant mice. At postnatal day 14, triple allele mutant mice exhibited micrognathia, midface hypoplasia, and a decreased facial angle due to shortened upper jaw length, premaxilla, and nasal bones, reflecting altered development of facial anterior-posterior elements. Mutant mice also showed increased palatal width, while other aspects of the facial transverse, as well as vertical dimensions, remained intact. As such, other ciliopathy-related craniofacial defects, such as cleft lip and/or palate, hypo-/hypertelorism, broad nasal bridge, craniosynostosis, and facial asymmetry, were not observed. Calvarial-derived osteoblasts of triple allele mutant mice showed reduced bone formation in vitro that was ameliorated by Hedgehog agonist, SAG. Together, these data indicate that Thm2 and Thm1 genetically interact to regulate bone formation and sculpting of the postnatal face. The triple allele mutant mice present a novel model to study craniofacial bone development. Full article