Soft Tissue Response to Orthognathic Surgery in Persons with Unilateral Cleft Lip and Palate

1993 ◽  
Vol 30 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Mark Ewing ◽  
R. Bruce Ross
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tissue Response ◽  
Soft Tissue Response

Soft Tissue Response to Orthognathic Surgery in Persons with Unilateral Cleft Lip and Palate

1993 ◽  
Vol 30 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Mark Ewing ◽  
R. Bruce Ross
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tissue Response ◽  
Appreciable Effect ◽  
Upper Lip ◽  
Anterior Maxilla ◽  
Maxillary Advancement ◽  
Soft Tissue Response

Individuals with cleft lip and palate often require Orthognathic surgery to establish facial harmony and optimal occlusal function. Surgery to the skeletal components of the face can accomplish predictable alterations in jaw relations. The soft tissue response to those skeletal movements, however, is difficult to predict, as it is also for the noncIeft individual. In addition there is the variability of the repaired cleft lip. The study included 30 persons with complete unilateral cleft lip and palate, operated for midface deficiency using a Le Fort I maxillary advancement at a mean age of 18.0 years. Some relapse occurred in the immediate postoperative period, but after 1 year the mean advancement of the maxilla was 4.9 mm (best fit of anterior maxilla) and 5.6 mm (incisai edge). Both skeletal and soft tissue changes were negligible after that time. The ratio of upper lip advancement to underlying incisor advancement was 0.65 to 1. Although the lip response was highly correlated to the underlying bony movement, the variation was sufficient to preclude accurate prediction. The upper lip thinned with maxillary advancement, but this was not related to the original lip thickness. Coincident mandibular surgery had no appreciable effect on upper lip movement.

Soft tissue response and facial symmetry after orthognathic surgery

2014 ◽  
Vol 42 (6) ◽  
pp. e339-e345 ◽  
Author(s):  
Kai Wermker ◽  
Johannes Kleinheinz ◽  
Susanne Jung ◽  
Dieter Dirksen
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Tissue Response ◽  
Facial Symmetry ◽  
Soft Tissue Response

Three-Dimensional Computer-Assisted Single-Splint 2-Jaw Cleft Orthognathic Surgery: Toward Patient-Centered Surgical Rationale

2020 ◽  
Vol 57 (12) ◽  
pp. 1428-1433
Author(s):  
Rafael Denadai ◽  
Yu-Ray Chen ◽  
Lun-Jou Lo
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Patient Centered ◽  
3 Dimensional ◽  
Facial Contour ◽  
Tissue Abnormalities

Skeletally mature patients with cleft lip and palate commonly present with skeletofacial deformities characterized by varying degrees of intrinsic and acquired dentoskeletal and soft tissue abnormalities. These abnormalities are associated with scarring from previous surgeries and the asymmetric midline and facial contour that impose challenges for adequate reconstruction. These patients frequently require 2-jaw orthognathic surgery to improve occlusal function and for correction of facial deformities. In this article, we have detailed a 3-dimensional computer-assisted single-splint 2-jaw orthognathic surgery technique as a surgical approach for cleft skeletofacial reconstruction, allowing for the surgery to be tailored according to the specific needs and requests of the patients. Further, we have addressed the multidimensionality and specificities of cleft treatment, the wide versatility, adaptability, and applicability of this technique, and the patient-centered rationale for the adoption of this method.

Comparing the Responses of Osseous Versus Soft-Tissue Metastases of Renal Cell Carcinoma to Receptor Tyrosine Kinase Inhibitors and Immunotherapy

Kidney Cancer ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 151-158
Author(s):  
Katherine Yuxi Tai ◽  
Jad M. El Abiad ◽  
Carol D. Morris ◽  
Mark Christopher Markowski ◽  
Adam S. Levin
Keyword(s):  
Renal Cell Carcinoma ◽  
Soft Tissue ◽  
Cell Carcinoma ◽  
Receptor Tyrosine Kinase ◽  
Renal Cell ◽  
Kinase Inhibitors ◽  
Tissue Response ◽  
Bone Response ◽  
Soft Tissue Response ◽  
Receptor Tyrosine Kinase Inhibitors

BACKGROUND: Checkpoint inhibitors and receptor tyrosine kinase inhibitors (RTKIs) have changed the standard of care for metastatic renal cell carcinoma (mRCC). Anecdotal evidence suggests these therapies may be less effective for treating bone than soft-tissue metastases. PURPOSE: We performed a retrospective review evaluating the relative clinical responses in soft-tissue and bone metastases in patients undergoing therapy using RTKIs and anti-programmed death-1 (PD-1) agents for mRCC. METHODS: Of the 2,212 patients in our institutional cancer registry with renal cell carcinoma (1997–2017), 68 (82 disease courses) were identified with measurable bone and soft-tissue metastases treated with RTKIs and/or PD-1s. Extent of metastasis was quantified at the time of therapy initiation (baseline) and at 3 months, 6 months, and 1 year. Changes in disease status were categorized as complete response, partial response, stable, mixed, or progression of disease according to RECIST v1.1 and MD Anderson criteria. These categories were further organized into “response to treatment” or “evidence of progression” to generate a generalized linear effects model with soft-tissue response as the independent variable and bone response as the dependent variable. Alpha = 0.05. RESULTS: Soft-tissue response correlated with bone response at 3 months (76 disease courses, p = 0.005) and 6 months (48 disease courses, p = 0.017). Of the patients with controlled soft-tissue disease, only 14 (19%) and 15 (32%) had progression in bone at 3 and 6 months, respectively. CONCLUSION: Contrary to anecdotal reports, osseous metastases do not appear to respond worse than soft-tissue metastases to treatment with these agents.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

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