Volume 92 Number 5

Der Einflup der Lippenplastik auf die Dentofaziale Entwicklung bei Patienten mit Lippen-Kiefer-Gaumen-Spalten 1. Jonas, H. F. Kappert, E. Reider, T. Rakosi, W. Schilli, and U. Joos Fortschr. Kiefemrthop. 1986:4W-1 I

The effect of primary lip repair on the dentofacial morphology was analyzed in 25 adolescents with cleft lip and palate by means of (a) upper lip pressure mea- surement, (b) electromyography of the labial muscu- lature, (c) roentgenocephalometric and soft-tissue anal- yses of the lateral head plate, and (d) plaster model analysis. The results were compared with those of 15 patients presenting with normal occlusal and functional relationships. Only the resting pressure of the upper lip correlated with the vertical and sagittal dentofacial mor- phology in patients with cleft lip and palate. This re- lation is attributed to the unbalanced and unfavorable functional-mechanical strain of the perioral muscles in these cases. The strain of the repaired upper lip on the underlying skeletal structures correlated with (a) the resting activity of the upper lip and (b) the strain di- rection being determined by the length and thickness of the labial sofit tissue. The results were specific for patients with cleft lip and palate, and were not corre- lated to the patient’s age and sex. Contrary to the dental parameters, the skeletal disturbances as a consequence of the muscular imbalance could not be significantly altered by orthodontic treatment. The choice of tech- nique of primaIy upper lip repair in patients with cleft lip and palate is important both for their dento- facial development and for their possible orthodontic Weatment result. Theoretically, from the functional- mechanical aspect, their results indicate that Delaire’s method of primary functional upper lip repair is the most suitable technique.

Alex Jacobson

Reviews and abstracts 447

Kieferorthop&dische Zlele und Ergebnlsse der Behandlung von Llppen-Klefer-Gaumen-Spalten Nach dem ‘Wiener Konzept’ D. Hoffmann and K. Hollmann Fortschr. Kieferorthop. 1986:429-45

The article describes the procedure of the “Viennese Concept” in the treatment of cleft lip and palate: (1) prolabium closure at the end of the first week of life, (2) velorrhaphy at the end of the first year of life, (3) rehabilitation of upper lip and nose at the end of

the fourth year, and (4) palatorrhaphy at the end of the sixth year of life. Conservative orthodontic treatment is only begun following velorrhaphy with a maxillary cover plate and continues until closure of the hard pal- ate. The goals of the “Viennese Concept” are as follows: (1) normal development of the maxilla and of the middle parts of the face, (2) normalized function of the oro- facial and velar muscles in due time to provide normal speech and auditory development, and (3) early reduc- tion of esthetic impairments to avoid late psychologic sequelae. To obtain objective assessment of maxillary growth, measurements on models were done. The re- sults show unimpaired growth of the maxilla up to the age of 12.

Alex Jacobson

Kieferorthopldische Forderungen fiir den VerschluP der Kieferspalten B. Kenig-Toll and J. Koch Fortschr. Kieferorthop. 1986:42/-a

As a result of the existing bone defect in the alveolar process caused by the unilateral and bilateral clefts, there is not only a weak point in the status of the max- illa, but also in the periodontium of the adjacent teeth in the cleft area. This causes early loss of those teeth. To maintain the permanent anterior teeth, the devel- opment of the periodontium should be promoted by bone grafting at the primary cleft palate closure before the eruption of the permanent anterior teeth. The peri- odontium is secured by the bony healing at the site of the cleft.

Alex Jacobson

FrUhversorgung und Wachstum des S&uglingsspaltkiefers P. Koppenburg, R. Schmelzle, M. Bather, D. Dausch-Neumann, N. Schwenzer, E. Leidig, H. Wolf, S. Dagenbach, and P. Lindenmiiller Fortschr. Kieferorthop. 1986:391-9

The integration of early maxillary orthopedic pro- cedures in the management of cleft lip and palate infants helps to provide favorable conditions for surgical treat- ment and further development of the dentition. This study sets out to investigate changes in maxillary mor- phology during early treatment by a three-dimensional approach with the aid of maxillary impressions. A new computer-assisted method is presented that directly re- cords from plaster casts the position of definite points

448 Reviews and abstracts Am. J. Orthod. Dentofac. Orthop. November 1987

with the spatial orthogonal coordinates. This is done with a newly developed opto-electronic noncontact pro- filometer. Graphical description of the measurements from the occlusal view is completed through uncoiling of the surface area of the space enclosed by a parallel baseline at the height of the dorsal lower surface of the vomer to the alveolar crest line and to the occlusal plane. This graphical description gives information on the growth and development of cleft palate infants when models are superimposed.

Alex Jacobson

Intraoral Self-Threading Screw Fixation for Sagittal Osteotomies: Early Experiences T. A. Turvey and D. J. Hall Int. J. Adult Orthodon. Orthognath. Surg. 1986;1:243-50

Since Trauner and Obwegeser stimulated interest in the sagittal osteotomy of the mandibular ramus, rigid fixation has become commonplace for the correction of a variety of mandibular deformities. According to the authors, essential for the success of this operation are (1) placement of the proximal segment to properly po- sition the condyle in the glenoid fossa and (2) securing the proximal segment to the distal segment without altering the ramus length.

The article represents the authors’ experience with 60 cases of transoral placement of self-threading screws to stabilize the proximal and distal segments following sagittal osteotomy. The results of the procedure so far have been favorable. According to the authors, tem- poromandibular joint fixation, occlusal changes, and neurosensory recovery are areas of fruitful investigation for the future.

Alex Jacobson

Maxillary Osteotomies Utilizing the Rigid Adjustable (RAP) System: A Review of 31 Clinical Cases FL A. Bays Int. J. Adult Orthodon. Orthognath. Surg. 1986;1:275-97 .

Positioning and stabilization of the maxilla follow- ing osteotomy is at times challenging to the surgeon because certain movements of the maxilla, such as ad- vancement, correction of asymmetries, superior posi- tioning when bone contact is poor, and practically all cleft osteotomies, are more problematic than others.

The primary purpose of fixation is to prevent post- operative movement of the maxilla while healing takes

place. Frequently, following repositioning of the max- illa, bony contacts are sparse owing to thin telescoping osteotomy sites on thin unsupporting bone. Interposed bone grafts at the points of minimal contact are tradi- tionally managed with a rigid fixation system using bone plates. The disadvantages of bone plating are that it can be a problem if insufficient bone thickness is not available and it allows for no postsurgical adjustment when the patient is under general anesthetic.

To overcome these problems, the author uses a rigid adjustable pin (RAP) system that, when properly placed, provides extremely stable and rigid fixation of the maxilla during the healing phase. The advantage of the procedure is that it allows for correct and precise positioning of the maxilla under anesthesia before final fixation. Data from 31 surgical cases with a minimum of 16 months are analyzed for complications and long- term stability, the latter of which was found to be ex- cellent. The article is well documented with excellent illustrations describing aspects of the system.

Alex Jacobson

Isometric Endurance of the Human Masseter Muscle During Consecutive Bouts of Tooth Clenching L. V. Christensen, S. E. Mohamed, and J. D. Rugh J. Oral Rehabil. 1985;12:509-14

Three adult male subjects in good health and with- out demonstrable dysfunctions of the mandibular lo- comotor system performed teeth clenching at maximum voluntary contraction of the mandibular elevator mus- cles. At lo-second intervals, ten successive bouts of clenching were conducted until total exhaustion of the contracting muscles occurred. The isometric endurance time decreased from 59 seconds to 12 seconds. The largest decline occurred between the first and second trials. Electromyographic recordings of the masseter muscles were taken during 10 seconds of maximum voluntary contraction and during the first and last of the series of endurance tests. The silent period was increased 35% from the first to last endurance test from a mean of 19 ms to a mean of 26 ms. The authors suggest that muscle and/or central nervous system fa- tigue may be factors in increasing the mean silent period observed during these trials.

The three subjects experienced severe pains in the masseter and anterior temporalis muscles, the zygo- matic arches, along the inferior border of the mandible, and in the tongue, the throat, the neck, and the shoulder girdle. Perspiration, pronounced tremors of the head