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Objective: The purpose of this study is to assess cleft rhinoplasty terminology across phases of growth., Design/setting: A systematic review was performed on cleft rhinoplasty publications over 20 years., Interventions: Studies were categorized by age at surgical intervention: infant (<1 year); immature (1 to 14 years); mature (>15 years)., Main Outcome Measures: Collected data included terminology used and surgical techniques., Results: The 288 studies included demonstrated a wide range of terminology. In the infant group, 51/54 studies used the term "primary." In the immature group, 7/18 studies used the term "primary," 3/18 used "secondary." In the mature group, 2/33 studies used the term "primary," 16/33 used "secondary," 2/33 used "definitive," 5/33 used terms such as "mature," "adult," and "late," and 8/33 did not use terminology., Surgical Technique Assessment Demonstrated: cleft rhinoplasty at infancy used nostril rim or no nasal incision, immature rhinoplasty used closed and open rhinoplasty incisions; and mature rhinoplasty used a majority of open rhinoplasty. Infant and immature cleft rhinoplasty incorporated septal harvest or spur removal in <10% of cases, whereas these procedures were common in mature rhinoplasty. No studies in infants or immature patients used osteotomies or septal grafts, common techniques in mature rhinoplasty., Conclusions: Current terminology for cleft rhinoplasty is varied and inconsistently applied across stages of facial development. However, cleft rhinoplasty performed at infancy, childhood, and facial maturity are surgically distinct procedures. The authors recommend the terminology "infant," "immature," and "mature" cleft rhinoplasty to accurately describe this procedure within the context of skeletal growth., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: A short columella, wide nostrils and a flat nasal tip are common features in patients with bilateral complete cleft lip and palate (BCLP). The objective of this study was to evaluate nasal morphology during growth in patients treated with naso-alveolar moulding (NAM) and primary surgical columella lengthening (PCL) compared with matched non-cleft individuals., Study Design: Prospective longitudinal case-control study., Participants and Methods: Thirty-four consecutively treated BCLP patients at 5 and 10 years and at the end of growth (19.7 ± 2.0 years) were compared through normalized photogrammetry to a control of 34 age and sex-matched non-cleft individuals. Regression Models for Panel Data assessed how nasal measurements were influenced by surgery, age and gender., Results: Nasal protrusion was equal to non-cleft controls at all ages. Length of the columella was also comparable to controls at 5 and 10 years, but significantly shorter at the end of growth. Inter-alar and nasal tip width and nasolabial angle were significantly wider than controls at all ages: More than 60% of the patients have asked for correction of the nasal width, but no early surgery for columella lengthening was needed., Conclusions: NAM and PCL have provided a nasal projection close to that of non-cleft individuals until adulthood, while length of the columella was physiological at 5 and 10, but shorter than controls at age 20. Width of the nasal tip and width of the alar bases were significantly wider than the controls and eventually required secondary nasal width correction in over two thirds of the sample., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Obstructive sleep apnea is common in patients with Crouzon syndrome, yet it may be caused by multiple factors. This study aims to investigate the natural history of airway development in preoperative Crouzon patients, from infants to adults. Methods: Preoperative computed tomography (CT) scans (Crouzon syndrome, n  = 73; control, n  = 87) were divided into five age subgroups. CT scans were measured using Materialise software. Results: Before 6 months of age, nasal airway volume in patients with Crouzon syndrome was smaller than normal by 37% ( p  = 0.002), and the cross-sectional area at the choana reduced by 45% ( p  < 0.001). The reduction of nasal airway volume and cross-sectional area reached their nadir at 2 years of age, with shortening of 44% and 63% (both p  < 0.001), respectively. They gradually caught up to normal dimensions after 6 years of age. Between 2 and 6 years, the pharyngeal airway in patients with Crouzon syndrome reduced 44% ( p  = 0.011) compared with controls. However, the airway cross-sectional area at condylion and gonion levels was less than normal, before 6 months (35%, p  = 0.024) and (44%, p  = 0.006) after 2 years of age, respectively. This reduction remains into adulthood. Conclusion: Nasal airway volume is more limited in children with Crouzon syndrome who are younger than 2 years of age. Whereas after 2 years of age, the pharyngeal airway develops significant volume restriction, leading to timing and specific treatment area foci based on the site of temporal maximal constriction.

Background: Primary rhinoplasty has not been universally adopted because the potential for nasal growth impairment remains an unsolved issue in cleft care. This study's purpose was to assess the long-term effects of primary rhinoplasty performed by a single surgeon in a cohort of patients with a unilateral cleft lip nose deformity., Methods: Three-dimensional nasal morphometric measurements (linear, angular, proportional, surface area, and volume) were collected from consecutive patients (cleft group, n = 52; mean age, 19 ± 1 year) who had undergone primary rhinoplasty with the use of the Noordhoff approach between 1995 and 2002 and reached skeletal maturity. Normal age-, sex-, and ethnicity-matched subjects (control group, n = 52) were identified for comparative analyses., Results: No significant differences (all p > 0.05) were observed for most measures, including nasal height, alar width, nasal dorsum angle, columellar angle, columellar-labial angle, nasal tip/height ratio, nasal index, alar width/intercanthal distance ratio, nasal surface area, and nasal volume. The cleft group displayed significantly (all p < 0.05) lower nasal bridge length and nasal tip projection, and greater nasal protrusion, tip/midline deviation, nasal tip angle, nasal tip protrusion width index, and alar width/mouth ratio values than the control group., Conclusions: Primary rhinoplasty does not interfere with nasal growth as measured by three-dimensional photogrammetric analysis. Further imaging studies are required for the assessment of development in other anatomical nasal structures., Clinical Question/level of Evidence: Therapeutic, IV.

Objective: Knowledge of age-related nasal region measurements in Anatolian men; growth changes between adult and old age., Background: The nose plays a critical role in determining the external appearance of an individual. Craniofacial anthropometry has been commonly used in forensic anthropology and medicine., Methods: A total of 300 men (100 between 20-40 years; 100 between 40-60 years and 100 60-up years) were measured using a photographic technic from the Image J program. From the landmarks, 13 linear distances and 3 angles were calculated and averaged for age groups., Results: The means of nasal bridge lengths of three age groups were 60.30, 63.43 and 64.63 mm, respectively. The average nasal tip protrusions of three groups were 24.31, 26.69 and 27.53 mm, respectively. Nasolabial angle, nasal bridge length and tip protrusion, anatomic and morphologic nose width and root width were statistically different between the three age groups (p < 0.05)., Conclusion: Results collected in this study could serve as a data bank for nasal anthropometry during aging and development. The assessment of teratogenic-induced traumas, craniofacial alteration, facial reconstruction, aging of dead person and personal identification may be assisted by age data from Anatolian men from age data banks., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: Orthodontists have long tried to predict future growth. It is one of the most difficult goals to achieve precisely despite the different methods of growth forecasting. A simple technique based on clinical and radiological analyses of the nose and premaxilla makes it possible, using no measurements, to accurately predict future maxillary growth and to deduce the therapeutic indications. A morphologic study of the nose is also an important item in the diagnosis of cranio-facial syndromes., Materials and Methods: Combining detailed semiologic and radiologic studies of the nasal and premaxillary structures, this article proposes a method for evaluating and predicting facial growth., Results: Experience based on many observations and current embryological knowledg can detect growth abnormalities of the ethmoïdo-nasal-premaxillary unit and provide valuable therapeutic information., Discussion: Combining clinical and radiologic analyses of nasal and premaxillary morphology is a good method to predict growth of the upper face. It is also an important feature in the diagnosis of cranio-facial syndromes., Conclusion: This technique should be included in the diagnosis of maxillo-dento-facial orthopedic cases., (© EDP Sciences, SFODF, 2018.)

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided., (© 2016 by the American College of Prosthodontists.)

Objectives: To establish normative data of upper airway structure in Chinese Han infants and preschool children., Methods: Magnetic resonance imaging (MRI) scans of 521 Chinese Han infants and preschool children (225 girls, 296 boys) aged from 1 day to 72 months were selected from the children who underwent head MRI at the Capital Institute of Pediatrics Affiliated Children Hospital, Beijing, China. No subjects had sleep-disordered breathing or associated conditions that may have affected the upper airway anatomy. The upper airway dimensions and surrounding soft tissue sizes were measured along the mid-sagittal and axial images., Results: On images from the mid-sagittal image, the normative values of the following were obtained for all age group: thickness of the adenoid and nasopharyngeal area, length and thickness of the soft palate, length and height of the tongue, length of upper airway, distance between the mental spine and clivus, and the adenoid oblique width, soft palate oblique width, and tongue oblique width along the mental spine-clivus line. Normative values of the mean tonsillar width and intertonsillar space on the axial images were also obtained. There were no differences in any measurements between boys and girls in either infants or preschool children. Older children had larger airway dimensions, as expected., Conclusion: Normative values for upper airway structure in Chinese Han infants and preschool children assessed by MRI were established. The upper airway dimension and surrounding soft tissues size, including soft palate, adenoid, tongue, and tonsils, were increased with age. There were no gender differences during the first six years of life. These data may prove useful when studying airway disease in Chinese Han children., (Copyright © 2017 Elsevier B.V. All rights reserved.)

There are limited numbers of studies comparing the preoperative and postoperative facial features of infants with unilateral cleft lip and palate (UCLP) using three-dimensional (3D) stereophotogrammetry. The authors attempted an anthropometric analysis of nasolabial asymmetry 1 year after primary lip repair using a handheld 3D imaging system. Five different nasolabial dimensions in 24 infants with UCLP were measured using 3D images captured during primary lip repair and again, 1 year after the repair. The nasal and upper-lip elements of the cleft side were significantly changed after primary lip repair, and nasolabial asymmetry was anthropometrically improved. This is a preliminary longitudinal observation of nasolabial growth in individuals with UCLP using 3D stereophotogrammetric technique. The authors would like to follow these children until adulthood, capturing 3D images at every intervention.

Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Repair of unilateral cleft lip and nasal deformity in three dimensions requires anticipation of changes in the fourth dimension that can be determined by periodic and objective assessment., Methods: Fifty patients with unilateral cleft lip with or without cleft palate underwent primary repair from 1999 to 2004 and were followed through 2014. Anthropometry was performed immediately postoperatively and at a first and second follow-up interval, occurring at an average age of 6.6 and 11.5 years, respectively. Measured differences between cleft and noncleft sides included heminasal width (subnasale-alare), cutaneous labial height (subnasale-crista philtri inferior, subalare-crista philtri inferior), and transverse labial width at the cutaneous-vermilion border (crista philtri inferior-chelion). Contrasts for the rates of growth were assessed with t tests for correlated measures. Using the same method, the difference between growth on cleft and noncleft sides in the second period was compared to that in the first period., Results: Heminasal width remained narrower on the cleft side, but this difference decreased over time. Subnasale-crista philtri inferior remained longer on the cleft side; there was no difference between the rate of growth on the cleft and noncleft sides in the second period. Subalare-crista philtri inferior remained shorter on the cleft side by a consistent difference at both times of follow-up measurements. Transverse labial width at the cutaneous-vermilion border remained shorter on the cleft side, but this difference decreased in the second period., Conclusion: Understanding how nasolabial features change with growth is critical to crafting the initial repair of unilateral cleft lip and nasal deformity., Clinical Question/level of Evidence: Therapeutic, IV.

The nasal cavity of strepsirrhine primates (lemurs and lorises) has the most primitive arrangement of extant primates. In nocturnal species, the numerous turbinals of the ethmoid bear a large surface area of olfactory mucosa (OM). In this study, we examine turbinal development in four genera of diurnal or cathemeral lemuriformes. In addition, we examined an age series of each genus to detect whether structures bearing OM as opposed to respiratory mucosa (RM) develop differently, as has been observed in nocturnal strepsirrhines. In adults, the maxilloturbinal is covered by highly vascular respiratory mucosa throughout its entire length, with large sinusoidal vessels in the lamina propria; any parts of other turbinals that closely borders the maxilloturbinal has a similar mucosa. Posteriorly, the most vascular RM is restricted in the nasopharyngeal duct, which becomes partitioned from the dorsal olfactory region. A comparison of newborns to adults reveals that the first ethmoturbinal increases more in length in the parts that are covered with RM than OM, which supports the idea that ethmoturbinals can specialize in more than one function. Finally, we observe that the regions of turbinals that are ultimately covered with RM develop more accessory lamellae or additional surface area of existing scrolls compared to the regions covered with OM. Because such outgrowths of bone develop postnatally and without cartilaginous precursors, we hypothesize that the complexity of olfactory lamellae within the ethmoturbinal complex is primarily established at birth, while respiratory lamellae become elaborated due to the epigenetic influence of respiratory physiology. Anat Rec, 299:1492-1510, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Potential integration between the nasal region and noncranial components of the respiratory system has significant implications for understanding determinants of craniofacial variation. There is increasing evidence that sexual dimorphism in body size and associated male-female differences in energetically relevant variables influence the development of the nasal region. To better understand this relationship, we examined the ontogeny of sexual dimorphism in nasal shape using a longitudinal series of lateral cephalograms., Methods: We collected a series of two dimensional coordinate landmark data from n = 20 males and n = 18 females from 3.0 to 20.0+ years of age totaling n = 290 observations across nine age groups. First, we tested whether there are sex differences in the nasal shape related to ontogenetic increases in body size (i.e., sitting height). Additionally, we examined whether there are male-female differences in patterns of nonallometric variation in nasal shape. Next, we tested whether there are sex differences in the strength of integration between the nasal region and other aspects of the facial skeleton., Results: Our results indicate that there are a number of similarities in patterns of morphological variation in the nasal region between males and females. However, as sitting height increases males exhibit a disproportionate increase in nasal region height that is not present in the female sample. Moreover, the male nasal region is less integrated with the surrounding facial skeleton when compared to the female sample., Conclusions: These results are consistent with the hypothesis that sex differences in nasal development are associated with male-female differences in energetically relevant variables., (© 2016 Wiley Periodicals, Inc.)

Objective: This study aims to establish the three-dimensional (3D) reconstruction model of nasal cavity for China's Han ethnic population (0-12 years) by laser scanning and photogrammetry, and thus to elucidate the developmental mechanism of nasal cavity morphology and nasolabial region., Patients and Methods: A total of 260 normal people of the Han ethnic aged 0-12 were recruited as subjects, among whom 60 were scanned for nasal cavity morphology in order to get reconstructed models with the computer engineering software. Photogrammetry was performed for the remaining 200 subjects to measure the 7 parameters that reflect vertically or horizontally the anatomical features of the nasolabial region., Results: The interior morphology of nasal cavity was accurately established by 3D laser scanning and photogrammetry with the optimal morphology of nasal cavity simulated through 3D reconstruction. Development of nasal cavity and nasolabial region was also analyzed., Conclusions: The 3D laser scanning analysis is the ideal method to analyze the interior morphology of nasal cavity by reconstructing the normal interior morphology of nasal cavity and quantitatively analyze the change of nasal cavity morphology with age. Photogrammetry can be applied to conduct the morphological measurement for the nasolabial region and, thus, assessing the development of the nasolabial region with age, which provides information for choosing the timing and options of surgery in treating harelip and nasal deformity.

Purpose: To compare the effectiveness of nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate presenting before and after 6 months of age and justify its use in older infants presenting for treatment., Materials and Methods: The university NAM protocol was followed for 150 patients who were included in the study. NAM was performed by 1 month of age (group I, n = 50), at 1 to 6 months of age (group II, n = 50), and at 6 months to 1 year of age (group III, n = 50). Seven linear anthropometric measurements were compared using dentofacial models., Results: Statistical analysis before and after NAM showed that group I had 83, 176, 69, and 142% improvement in intersegment distance, nasal height, nasal dome height, and columella height, respectively. Group II had 53, 44, 30, and 67% improvement. Group III had 45, 38, 28, and 62% improvement., Conclusion: Patients in all 3 groups showed improvement with the NAM protocol. Although patients who presented for treatment before 1 month of age benefited the most, those who presented at 6 months to 1 year of age benefited as much from NAM as those who presented at 1 to 6 months, thus validating its use in these patients., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Unilateral cleft lip (UCL) patients have lip and nose deformities that must be addressed during lip repair. Currently, devices to achieve lip and nose improvements have been developed. The most researched presurgical molding device is the nasoalveolar molding (NAM), which has shown favorable results. However, clinical observation shows that unilateral cleft patients, even without molding devices, achieve spontaneous improvements. The aim of this study is to compare morphological and symmetry changes in nose and lip, between patients less than 30-day old and those submitted to cheiloplasty, at 6 months of age., Materials and Methods: A total of 27 UCL patients with 2 photographs were selected. The pictures were taken from frontal view and nasal base view at 2 distinct moments: before 30 days of life (t1) and at 6 months of age, during cheiloplasty surgery (T2). Images were analyzed with indirect measurement to assess lip and nose dimensions and nasal symmetry. ImageJ software was used to perform the analyses., Results: A total of 20 patients (P < 0.05) had an average cleft width reduction of 15% [standard deviation (SD) ± 11%]. A 55% average increase (SD ± 29%) was observed in nostril height of cleft side in 16 of patients (P < 0.05). There was an reduction in facial asymmetry of nostril width (P < 0.05), from 95% (SD ± 90%) (t1) to 59% (SD ± 50) (T2). Also, nasal base width asymmetry (P < 0.05) was decreased from 64% (SD ± 66%) (t1) to 40% (SD ± 29%) (T2)., Conclusion: Facial growth causes a natural improvement on cleft morphological changes and nasal symmetry.

Objective: The primary objective of this study was to investigate whether growth impairment in children with cleft lip is caused by reconstructing the nostril floor using lateral nasal and premaxillary mucoperiosteal flaps. The effects on growth and symmetry of tip rhinoplasty at the time of initial repair, as well as cleft sidedness are similarly investigated., Methods: An Institutional Review Board approved, retrospective, single-center study at an academic children's hospital from July 2005 to 2010 was designed. Seventy-four patients with unilateral cleft lip ± palate were followed postsurgical repair of the cleft lip deformity. Serial digital photographs from clinical encounters were analyzed. Anthropometric measurements of 10 soft tissue landmarks were extracted from anteroposterior and submental vertex views at serial visits; growth velocities, defined as c = Δd/Δt, were generated using linear mixed models on selected measurements to study time-related changes on growth. The effects on growth and symmetry of primary tip rhinoplasty on perinasal landmarks and nostril floor reconstruction with medial and lateral nasal mucoperiosteal flaps on perioral and perinasal landmarks were analyzed. Proxies for midfacial height (en-al) and maxillary height (al-ch) were used to evaluate the effect of mucoperiosteal dissection, whereas nostril width, height, and angle were used as proxies to evaluate the effects of tip rhinoplasty., Results: Seventy-four patients met the inclusion criteria. Midface height (En-Al) growth velocity was 0.014 mm/month and maxillary height (Al-Ch) was relatively stable at -0.0059 mm/month with no difference between the subgroups. Nostril height growth was -0.0046 mm/month, nostril width was 0.03 mm/mo, and nostril angle -0.09 °/mo showed no difference between patient with or without primary tip rhinoplasty. Patients with complete cleft showed more asymmetry than those with incomplete clefts in lip and maxillary landmarks at T0 (P < 0.001)., Conclusions: Mucoperiosteal reconstruction of the nostril floor at the time of lip repair does not affect anthropometric growth velocities over a 5-year follow-up. Within the limitations of the selected landmarks, primary tip rhinoplasty did not significantly improve symmetry at 5 years, but also did not affect the growth of the nose. Patients with complete clefts display more postoperative asymmetry than those with incomplete clefts.

Nasal growth after cleft lip surgery with or without primary nasal repair was evaluated using lateral cephalograms. In 14 patients who underwent simultaneous nasal repair with primary cleft lip repair and 12 patients without simultaneous nasal repair, lateral cephalograms were obtained at 5 and 10 years of age. Lateral cephalograms of normal Japanese children were used as a control. At 5 years of age, there were significant differences in the nasal height and columellar angle among the three groups. Children without simultaneous nasal repair had shorter noses with more upward tilt of the columella compared with the controls, while children with simultaneous nasal repair had much shorter noses and more upward tilt than those without repair. At 10 years of age, the children without simultaneous nasal repair showed no differences from the control group, while those with simultaneous repair still had shorter noses and more upward tilt of the columella. These findings suggest that performing nasal repair at the same time as primary cleft lip surgery has an adverse influence on the subsequent growth of the nose., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

This article presents a technique for fabricating a modified nasoalveolar molding appliance using 0.032-inch titanium-molybdenum alloy wire for nasal stents incorporating a double loop. The nasal stents are included in the acrylic molding plate at the time the appliance is inserted. The acrylic retention button used in a conventional appliance is replaced by a simple retention hook fabricated using titanium-molybdenum alloy wire. This technique is an effective alternative to a conventional appliance, and it simplifies the appliance-modification process during follow-up visits.

Children noses have special anatomical and functional characteristics. Early interventions performed before the end of the child's growth have been a main topic as they may cause adverse effects on the subsequent development and the function. This chapter describes the characteristics of the nasal pyramid and the septum at different stages of growth. Should one's approach be very cautious in children surgical indications, one should not hesitate opting for the treatment of congenital malposition or acquired when they jeopardize the nasal function. Considering possible procedures and specific conditions within pediatric field are discussed in this chapter., (Copyright © 2014. Published by Elsevier Masson SAS.)

In the appropriately selected patient, septorhinoplasty can benefit a pediatric patient presenting with significant nasal trauma, abscess, or mass that will likely result in a progressive deformity in the growing nose or with negative functional or psychosocial effect. Clinical and experimental observations support a conservative approach to cartilage scoring and resection in pediatric patients in which septorhinoplasty is deemed necessary., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The nasal septum plays an important role in nasal growth, but there have been few reports on the relationship between the septum and nasal growth. The authors investigated the relationship between septa and external noses using computed tomography during the growth period., Methods: One hundred and ninety-eight patients under the age of 21 were enrolled in this study between 2008 and 2012. The authors evaluated a total of 9 measurement items (five for nasal bones and septa, and four for external noses)., Results: In the final age group, most measurement items were significantly larger in males than in females. However, there was no remarkable difference between male and female growth processes. Nasal bridge length and nasal height were significantly correlated with the nasal bone or septum in almost all age groups. The relative proportion of the cartilaginous septum decreased significantly with age, and was negatively correlated with the perpendicular plate in all age groups., Conclusions: Nasal septa and external noses were both larger in males than in females at the beginning of the study period, although not significantly. The differences became significant throughout the study due to differential increases between the sexes during the monitored growth spurts., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: The purpose of this study was to evaluate the concept that the affected and contralateral sides do not grow at the same rate in patients with hemifacial microsomia. Changes in the cranial base, maxilla, mandible, and occlusal plane were evaluated on 3-dimensional images from cone-beam computed tomography data in untreated patients., Methods: Six patients were classified as having mandibular Pruzansky/Kaban type I, IIA, or IIB hemifacial microsomia. Cone-beam computed tomography (MercuRay; Hitachi, Tokyo, Japan) scans were taken before orthodontic treatment during both growth and postpuberty periods., Results: The cranial base as defined by the position of the mastoid process was in a different position between the affected and contralateral control sides. The nasomaxillary length or height was shorter on the affected side for all 6 patients with hemifacial microsomia regardless of its severity, and it grew less than on the contralateral control side in 5 of the 6 patients. The occlusal plane angle became more inclined in 4 of the 6 patients. The mandibular ramus was shorter on the affected side in all patients and grew less on the affected side in 5 of the 6 patients. The mandibular body grew slower, the same, or faster than on the control side., Conclusions: The cranial base, position of the condyle, lengths of the condyle and ramus, and positions of the gonial angle and condyle can vary between the affected and contralateral control sides of patients with hemifacial microsomia, with the ramus and nasomaxillary length usually growing slower than they grow on the control side. These results suggest that many factors affect the growth rate of the craniofacial region and, specifically, the mandible in patients with hemifacial microsomia., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Tooth extractions, apart from the third molars, which it seems is normal to extract today, have always given rise to controversy among orthodontists with both supporters and opponents. It is legitimate to raise the question regarding the need for extractions in our treatment plan and to opt for the first or second premolars as the extraction site, or even the first molars when the latter are decayed and the germs of the third molars are in place. Facial esthetic guides us in our treatment decisions but we must free ourselves from the so-called esthetic lines drawn up many years ago and, for the most part, on the basis of lateral headfilms and small study samples. Particular ethnic features are another major factor to be borne in mind, given that the vast majority of cephalometric standards were based on Caucasian populations. In this article, we will draw on clinical studies to illustrate the thinking behind the need for extractions and the choice of extraction sites., (Copyright © 2014 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: The human respiratory airway undergoes dramatic growth during infancy and childhood, which induces substantial variability in air flow pattern and particle deposition. However, deposition studies have typically focused on adult subjects, the results of which cannot be readily extrapolated to children. We developed models to quantify the growth of human nasal-laryngeal airways at early ages, and to evaluate the impact of that growth on breathing resistance and aerosol deposition., Methods: Four image-based nasal-laryngeal models were developed from 4 children, ages 10 days, 7 months, 3 years, and 5 years, and were compared to a nasal-laryngeal model of a 53-year-old adult. The airway dimensions were quantified in terms of different parameters (volume, cross-section area, and hydraulic diameter) and of different anatomies (nose, pharynx, and larynx). Breathing resistance and aerosol deposition were computed using a high-fidelity fluid-particle transport model, and were validated against the measurements made with the 3-dimensional models fabricated from the same airway computed tomography images., Results: Significant differences in nasal morphology were observed among the 5 subjects, in both morphology and dimension. The turbinate region appeared to experience the most noticeable growth during the first 5 years of life. The nasal airway volume ratios of the 10-day, 7-month, 3-year, and 5-year-old subjects were 6.4%, 18.8%, 24.2%, and 40.3% that of the adult, respectively. Remarkable inter-group variability was observed in air flow, pressure drop, deposition fraction, and particle accumulation. The computational fluid dynamics predicted pressure drops and deposition fractions were in close agreement with in vitro measurements., Conclusions: Age effects are significant in both breathing resistance and micrometer particle deposition. The image/computational-fluid-dynamics coupled method provides an efficient and effective approach in understanding patient-specific air flows and particle deposition, which have important implications in pediatric inhalation drug delivery and respiratory disorder diagnosis.

Objective: To study the longitudinal changes in 19 soft tissue cephalometric traits (according to the Bergman cephalometric soft tissue facial analysis)., Materials and Methods: Cephalograms and photographs of 40 subjects (20 male, 20 female, from the Burlington Growth Centre) that were obtained at ages 6, 9, 12, 14, 16, and 18 years were used. Subjects were orthodontically untreated whites and had Class I dentoskeletal relationships (ideal overjet and overbite). Images were obtained with the lips in a relaxed position or lightly touching., Results: Three groups of soft tissue traits were identified: (1) traits that increased in size with growth (nasal projection, lower face height, chin projection, chin-throat length, upper and lower lip thickness, upper lip length, and lower lip-chin length); (2) traits that decreased in size with growth (interlabial gap and mandibular sulcus contour [only in females]); and (3) traits that remained relatively constant during growth (facial profile angle, nasolabial angle, lower face percentage, chin-throat/lower face height percentage, lower face-throat angle, upper incisor exposure, maxillary sulcus contour, and upper and lower lip protrusion)., Conclusion: Current findings identify areas of growth and change in individuals with Class I skeletal and dental relationships with ideal overjet and overbite and should be considered during treatment planning of orthodontic and orthognathic patients.

Background: Primary repair of bilateral incomplete cleft lip appears to be uncomplicated but requires attention to technical details in the third dimension in anticipation of changes in the fourth dimension., Methods: Direct anthropometry was used to document nasolabial dimensions before and immediately after repair in 51 infants with bilateral incomplete cleft lip. Technical details were analyzed in 48 patients; serial anthropometry was plotted in 22 male patients aged 2 to 20 years and compared to Farkas's normal growth lines. Revisions were also documented (n = 46)., Results: Nasal width was made narrow and widened to normal by adolescence. Nasal tip protrusion was elongated and grew parallel to normal. Columellar length was constructed above normal, lengthened slowly in childhood, and was slightly short by adulthood. The Cupid's bow was designed narrow, widened slightly, and maintained normal dimension in adulthood. The upper philtrum was tapered and remained less wide than the lower philtrum. Although maximum available cutaneous prolabium was used in repair, it was short postoperatively and philtral height failed to exhibit catchup growth. The median tubercle was constructed overly full, but growth frequently fell behind in adolescence; 39 percent of patients required secondary augmentation. Total upper labial height closely followed the normal growth curve., Conclusions: Serial anthropometry documented postoperative changes in nasolabial dimensions compared with normal growth lines. Repair of bilateral incomplete cleft lip requires primary correction of nasal and labial features based on their differential growth., Clinical Question/level of Evidence: Therapeutic, IV.

Background: The purpose of this study was to characterize soft-tissue profile changes following Le Fort III (midface) distraction in growing patients with syndromic craniosynostosis., Methods: The cohort consisted of 20 syndromic patients who underwent Le Fort III osteotomy with midface advancement using a rigid external distraction device. The mean age at surgery was 5.7 years (range, 3 to 12.5 years). Lateral cephalograms were obtained preoperatively (time 1), after distraction device removal (time 2), and 1 year after distraction (time 3). Ten skeletal hard-tissue and 11 soft-tissue profile landmarks were identified and digitized at time points 1, 2, and 3. The x and y displacement of each landmark was studied to determine the ratios for soft- to hard-tissue change., Results: The horizontal ratio of soft- to hard-tissue change for nasal dorsum to orbitale was 0.73:1 and the soft-tissue tip of nose to the anterior nasal spine was 0.86:1. The horizontal ratio of soft-tissue A point to hard-tissue A point was 0.88:1. The horizontal ratio of the upper lip position to the labial surface of maxillary incisor was 0.88:1. The ratio for nasal tip elevation to the anterior nasal spine advancement was 0.27:1., Conclusions: The result of this study supported the hypothesis that there exists a linear relationship between soft- and hard-tissue changes in the horizontal direction for the midface landmarks following Le Fort III distraction. However, there was a nonlinear relationship between soft- and hard-tissue changes in the vertical direction., Clinical Question/level of Evidence: Therapeutic, IV.

Objective: This study evaluated the effectiveness of computer-aided design-nasoalveolar molding (CAD-NAM) on maxillary alveolar morphology in infants with unilateral cleft lip and palate (UCLP)., Methods: 15 infants with UCLP treated by CAD-NAM therapy composed the treatment group, and the control group consisted of 15 infants with non-presurgically treated UCLP. The maxillary morphology was analyzed by Rapidform XOR3 software. Differences in all variables pre- and post-CAD-NAM were discussed., Results: Significant difference was found in arch length, cleft gap, labial frenum deviation, A-X, A'-X, and alveolus height on both sides pre- and post-CAD-NAM., Conclusions: This study suggests a trend toward morphological improvement in maxillary alveoli of infants with UCLP treated with CAD-NAM. The CAD-NAM effectively reduced the cleft gap, corrected the maxilla midline, and improved the sagittal length of the maxilla. The alveolar height decreased significantly after the treatment, which indicated that the traction force of the appliance may have obstructive effects on the vertical growth of the alveolar bone., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A new specimen attributable to an immature individual of Pachyrhinosaurus perotorum (Dinosauria, Ceratopsidae) from the Kikak-Tegoseak Quarry in northern Alaska preserves a mix of features that provides refinement to the sequence of ontogenetic stages and transformations inferred for the development of the nasal boss in Pachyrhinosaurus. The new specimen consists of an incomplete nasal that includes the posterior part of the nasal horn, the dorsal surface between the horn and the left-side contacts for the prefrontal and frontal, and some of the left side of the rostrum posteroventral to the nasal horn. The combination of morphologies in the new specimen suggests either an additional stage of development should be recognized in the ontogeny of the nasal boss of Pachyrhinosaurus, or that the ontogenetic pathway of nasal boss development in P. perotorum was notably different from that of P. lakustai. Additionally, the presence of a distinct basal sulcus and the lateral palisade texture on the nasal horn of the specimen described here indicate that a thick, cornified horn sheath was present well before the formation of a dorsal cornified pad. A separate rugose patch on the nasal well posterior to the nasal horn is evidence for a cornified integumentary structure, most likely a thick cornified pad, on the posterior part of the nasal separate from the nasal horn prior to the onset of nasal boss formation in P. perotorum.

Objectives: By finding the mean value of anthropometric parameters in normal samples of a population, it is possible to create a template for facial analysis. The aim of our study was to measure the anthropometric parameters in 0- to 12-year-old girls of Fars ethnic origin in the Northeast of Iran., Study Design: Six hundred sixty-two newborn to 12-year-old girls of Fars ethnic origin participated in the study. A digital camera was used to take frontal full-face photographs of each child. Thirteen measurements were taken with the Smile Analyzer software: al-al, ch-ch, en-en, ex-ex, ft'-ft', go'-go', t-t, zy'-zy', n'-gn', n'-sn, t-g', t-gn', t-sn. Data were analyzed using the SPSS software at the significance level of 0.05., Results: In almost all parameters, we found significant growth acceleration between 2 and 4 years as well as 5 and 6 years of age. Another growth spurt was seen between 9 and 11 years, although it was less noticeable. Comparing the linear regression equations suggests that different craniofacial dimensions do not grow similarly., Conclusions: By age, craniofacial dimensions change at different rates. Different craniofacial dimensions do not grow at consistent rates. Some parts grow slower compared with others. The intercanthal width has the slowest growth. Facial height shows the fastest growth.

Severe bilateral cleft-lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5-day-old male infant with bilateral cleft-lip-palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft-lip/palate cases, simple modifications in the appliance can achieve rapid results., (© 2012 by the American College of Prosthodontists.)

Objective: To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times., Design: This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level., Results: The data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4-12 years had smaller Y-axis angle than those operated on before 4 years of age., Conclusions: The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4-12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12 years., (Copyright © 2012 European Assocation for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The present study was undertaken to investigate the changes in the normal upper airway during growth and development using 3-dimensional computer analysis from cone-beam computed tomography (CBCT) data to provide a normative reference., Methods: The airway size and respiratory mode are known to have a relationship to facial morphology and the development of a malocclusion. The use of CBCT, 3-dimensional imaging, and automated computer analysis in treatment planning allows the upper airway to be precisely evaluated. In the present study, we evaluated the growth of the airway using 3-dimensional analysis and CBCT data from age 6 through old age, in 1300 normal individuals., Results: The airway size and length increase until age 20 at which time a variable period of stability occurs. Next, the airway at first decreases slowly in size and then, after age 40, more rapidly. Normative data are provided in the present study for age groups from 6 to 60 years in relation to the airway total volume, smallest cross-sectional area and vertical length of the airway., Conclusions: This 3-dimensional data of the upper airway will provide a normative reference as an aid in the early understanding of respiration and dentofacial anatomy, which will help in early treatment planning., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results., (Copyright © 2012 by Thieme Medical Publishers, Inc.)

Objectives: Controversy has surrounded the procedure of pediatric septoplasty since the 1950s due to concerns over an adverse effect on nasal and facial growth. However, more recent evidence has demonstrated that septoplasty can be safely performed without affecting nasal and facial development in the appropriately selected pediatric patient. The purpose of this article is to establish the impact of pediatric septoplasty on nasal and facial growth and review the clinical indications and evidence for timing of surgery according to the most recent literature., Methods: A structured review of the PubMed, Ovid Medline and Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the terms: pediatric, childhood, septoplasty, nasal septum, indications, nasal growth and facial growth., Results: Three long term follow up studies using anthropometric measurements were identified which concluded that pediatric septoplasty does not interfere with normal nasal or facial development. A further similar study concluded that external septoplasty does not affect most aspects of nasal and facial growth, but may negatively influence growth of the nasal dorsum. Furthermore, one study demonstrated that a group of children with symptomatic uncorrected deviated nasal septum had a statistically significant increased occurrence of facial and dental anomalies compared with age and sex matched controls, therefore supporting a role for septoplasty., Conclusions: Evidence exists to support that pediatric septoplasty can be performed without affecting most aspects of nasal and facial growth. Furthermore, not performing or delaying septoplasty when indicated may adversely affect nasal and facial growth with compounding adverse effects in terms of deformity and asymmetry. Despite the majority advocating the timing of septal surgery to be 6 years and older, more clinical studies are required that may provide further evidence for correction of septal deviations in younger children, perhaps even at birth., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

In this study we determined whether craniofacial development in rats could be influenced by an early temporary (3 d) nasal obstruction associated with forced oral breathing. The rats were killed at specific time points after surgery. Plasma samples were taken for biochemical analyses, and cephalometric measurements were performed. Shortly after nasal obstruction, the vertical nasomaxillary complex and the longitudinal skull base proved to be smaller in both sexes of test rats compared with controls. This was maintained in male rats but not in female rats. In female rats, only the longitudinal skull base remained somewhat shorter as the animals grew older. Reversible nasal obstruction was further associated with reduced dimensions of the olfactory bulbs lasting into adulthood and an initial decrease in lung weight. One day after implementing nasal obstruction, basal corticosterone levels had increased (by over 1,000%) and stayed at a high level in female rats. In male rats, however, the corticosterone level seemed to return to normal by day 90. Oral breathing was also associated with a lower level of thyroid hormone, especially at the shorter term intervals in both sexes. We conclude that a 3-d nasal obstruction period in young rats leads to long-term hormonal changes and to craniofacial structural adaptation., (© 2011 Eur J Oral Sci.)

This article focuses on current practices and controversy in the area of presurgical infant orthopedics in patients born with cleft lip and palate.

Anthropometry, a useful method for evaluating craniofacial soft tissues, makes the quantitative description of the face possible. It also assesses the degree of disharmony and imbalance in the growth and development of the face. The aim of this study was to examine the overall common age-related changes of nasomaxillary complex of adolescent boys in northeast Iran. Three- hundred- twelve 12 to 15 year-old boys voluntarily participated in this study. They were divided into three age groups (12-13, 13-14 and 14-15 year-old groups). Digital photographs of the subjects' faces were taken in Natural Head Position (NHP) frontal and profile views. After determination of the landmarks, nine anthropometric parameters including nasal length, mouth width, alar width, columella width, philtrum height, nasal width, nasolabial angle, nasal root slope angle and nasal index were measured by the Smile Analyzer software considering the magnification ratio of each image. One way ANOVA and Tukey test were used for statistical analyses. Significant differences between the three groups were detected in the mean alar, mouth and philtrum widths, nose length, nasolabial angle and nasal index (P<0.05). We did not find any significant differences in the mean nasal-root-slope angle and the mean philtrum height between the groups (P=0.29 and P=0.13, respectively). Aging of the facial profile is not a gradual process; it occurs in spurts and at different periods of life. During the studied time span, significant growth in nose width and nose length was obvious.

Many practitioners find the complexity of facial growth overwhelming and thus merely observe and accept the clinical features of atypical growth and do not comprehend the long-term consequences. Facial growth and development is a strictly controlled biological process. Normal growth involves ongoing bone remodeling and positional displacement. Atypical growth begins when this biological balance is disturbed With the understanding of these processes, clinicians can adequately assess patients and determine the causes of these atypical facial growth patterns and design effective treatment plans. This is the first of a series of articles which addresses normal facial growth, atypical facial growth, patient assessment, causes of atypical facial growth, and guiding facial growth back to normal.

The impact of facial asymmetry on nasal deviation is an accepted but poorly understood part of plastic surgery and rhinology training. Recently, an increased understanding of the specific structural issues underlying this deformity has led to improved surgical techniques and patient outcomes., (© Thieme Medical Publishers.)

Although serious trauma injuries are uncommon in the pediatric population, nasal injuries are a more common problem. In this population, many physicians are uncomfortable managing these injuries. The evaluation and treatment of nasal trauma differ considerably in children compared with adult nasal fractures. Poor patient cooperation during the physical exam coupled with significant anatomic differences can present the nasal surgeon with a difficult diagnostic dilemma. The surgical management of pediatric nasoseptal injuries is not without controversy, as disturbing the nasal growth centers can have significant effect on future nasal and midfacial development. This article reviews the diagnostic and therapeutic challenges presented by these injuries for children and provides recommendations to successfully manage nasal injuries in this population., (© Thieme Medical Publishers.)

Background: Accurate diagnosis of dental maturation help in diagnosis, treatment planning, and timing in orthodontics and dentofacial orthopedics., Aim and Objective: The present study is undertaken to compare and correlate chronological age and dental age of patients with average, vertical, and horizontal facial types, and to find out any sex difference in dental age in different growth patterns and to evaluated the reliability of Willem's method in Indian population., Materials and Methods: Subjects in the age group of 8-10 years were screened from Out Patients Department of Orthodontics and Dentofacial Orthopedics and from the various school of the City, were subjected to cephalometric radiography and orthopentomograms. Angular and linear measurements used included;-SN Go-Gn angle, J.R. (Jarabak ratio) and LAFH (lower anterior facial height), to group total sample of 150 children. Group 1 (average grower), Group 2 (vertical grower), and Group 3 (horizontal grower). Then dental age for each child in different group was calculated from OPG of each subject and compared with chronological age using Student t-test., Results: The results suggest a difference in dental age in subject with vertical and horizontal growers. Vertical grower showed earlier maturation compared to horizontal growth patterns. There was insignificant difference present when vertical grower and horizontal grower were compared with average growth pattern. Insignificant difference was found in dental age between males and females when compared to same growth pattern., Conclusion: Subjects with vertical growth pattern matured early than having the horizontal growth pattern in the same chronological age.

Introduction: Because of limited available reference data, this study described the vertical growth changes that occur in untreated adolescents 10 to 15 years of age and evaluated the validity of measurements commonly used to classify patients' vertical growth tendencies., Methods: The sample consisted of 228 subjects (119 boys, 109 girls) between 10 and 15 years of age with normal occlusions or malocclusions who had lateral cephalograms (n = 1303) taken annually. Based on 6 landmarks, 3 angles (PPA, MPA, PP/MPA) and 2 proportions (PFH:AFH and UFH:LFH) were calculated. To reduce errors, each subject's growth curve was estimated by using multilevel modeling procedures, and the estimated values were analyzed., Results: Growth changes between 10 and 15 years for each of the 5 measurements followed relatively simple (linear or quadratic) polynomial models. On average, PPA and PFH:AFH increased, and MPA and PP/MPA decreased. The UFH:LFH ratio increased during the first few years and then decreased. MPA, PP/MPA, and PFH:AFH showed moderately high intercorrelations; PPA displayed moderate to moderately low correlations with UFH:LFH; UFH:LFH showed a moderate correlation with PP/MPA. Approximately 75% to 86% of the subjects classified as hyperdivergent or hypodivergent at 10 years maintained their classification. Subjects classified as hyperdivergent at 15 years of age showed significantly greater growth changes than did those classified within normal limits, who, in turn, showed greater changes than did the hypodivergent subjects., Conclusions: Measurements typically used to classify vertical growth tendencies changed significantly during adolescence, with boys generally showing greater changes than girls. Although MPA, PFH:AFH, and PP/MPA measured the same phenotypic attribute, PPA and UFH:LFH were relatively independent of the other 3 measurements. Most subjects maintained their vertical facial types, but some worsened, and others improved., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The aim of this article was to present a new method of analysis for the assessment of facial growth and morphology after surgical resection of the mandible in a growing patient., Methods: This was a 2-year longitudinal study of facial growth in a child who had undergone segmental resection of the mandible with immediate reconstruction as a treatment for juvenile aggressive fibromatosis. Three-dimensional digital stereo-photogrammteric cameras were used for image acquisition at several follow-up intervals: immediate, 6 months, and 2 years postresection. After processing and superimposition, shell-to-shell deviation maps were used for the analysis of the facial growth pattern and its deviation from normal growth. The changes were seen as mean surface changes and color maps. An average constructed female face from a previous study was used as a reference for a normal growth pattern., Results: The patient showed significant growth during this period. Positive changes took place around the nose, lateral brow area, and lower lip and chin, whereas negative changes were evident at the lower lips and cheeks area. An increase in the vertical dimension of the face at the chin region was also seen prominently., Conclusions: Three-dimensional digital stereo-photogrammetry can be used as an objective, noninvasive method for quantifying and monitoring facial growth and its abnormalities., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Morphogenesis of the vertebrate facial skeleton depends upon inductive interactions between cephalic neural crest cells (CNCCs) and cephalic epithelia. The nasal capsule is a CNCC-derived cartilaginous structure comprising a ventral midline bar (mesethmoid) overlaid by a dorsal capsule (ectethmoid). Although Shh signalling from the anterior-most region of the endoderm (EZ-I) patterns the mesethmoid, the cues involved in ectethmoid induction are still undefined. Here, we show that ectethmoid formation depends upon Dlx5 and Dlx6 expression in a restricted ectodermal territory of the anterior neural folds, which we name NF-ZA. In both chick and mouse neurulas, Dlx5 and Dlx6 expression is mostly restricted to NF-ZA. Simultaneous Dlx5 and Dlx6 inactivation in the mouse precludes ectethmoid formation, while the mesethmoid is still present. Consistently, siRNA-mediated downregulation of Dlx5 and Dlx6 in the cephalic region of the early avian neurula specifically prevents ectethmoid formation, whereas other CNCC-derived structures, including the mesethmoid, are not affected. Similarly, NF-ZA surgical removal in chick neurulas averts ectethmoid development, whereas grafting a supernumerary NF-ZA results in an ectopic ectethmoid. Simultaneous ablation or grafting of both NF-ZA and EZ-I result, respectively, in the absence or duplication of both dorsal and ventral nasal capsule components. The present work shows that early ectodermal and endodermal signals instruct different contingents of CNCCs to form the ectethmoid and the mesethmoid, which then assemble to form a complete nasal capsule.

The purpose of this article is to present a long-term follow-up of the growth of the face and the nasomaxillary complex in a pair of identical twins, one of whom had suffered severe midfacial trauma at age 2 years. Growth of the face and the nasomaxillary complex was longitudinally assessed and compared by means of facial photographs and cephalometric x-rays. Twin A suffered Le Fort II and III fractures with an associated frontal bone injury in early childhood and subsequently developed significant midface hypoplasia; twin B had no trauma and normal facial growth and development. Facial profile difference between the twins gradually became more pronounced until age 19. Twin A had obvious retrusion of the midfacial region, including the nasal bones on visual examination and radiographic study. At age 20, she underwent orthognathic surgical correction of the traumatic deformity. Her unaffected sibling, twin B, provided the genetic facial phenotype for the surgical orthognathic reconstruction., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

We use histological techniques and computer-aided three-dimensional reconstructions made from serial histological sections to describe the ontogeny of the ethmoidal endocranium of discoglossid frog Discoglossus pictus. We identify a pattern of development for the suprarostral cartilage that differs from previous findings and probably represents the ancestral anuran pattern. The nasal cartilages, including the inferior prenasal cartilage, are de novo adult structures. The only larva-derived structures of the adult nasal capsules are the posterior aspects of the solum nasi and septum nasi. We also identify patterns of development for the ethmoid plate and postnasal wall that occur during early in ontogenesis. These patterns are associated with development events during metamorphic climax. The pattern of timing of chondrification of the anterior nasal cartilages more closely coincides with that of the neobatrachian species than that recorded for the pelobatid frog Spea. In addition, this study supports a sister taxon relationship between Discoglossus and Alytes.

In the past orthodontists frequently used extra-oral force to slow down skeletal growth in their treatment of Class II malocclusions; more modern practice relies less on applying distal force to the maxilla than on stimulating forward growth of the mandible. Does this change in therapeutic design have any repercussions in facial esthetics? To evaluate the impact of treatment on the appearance of the profile, we conducted a study with 64 patients in the adolescent dentition stage with a Class II, division 1 malocclusions. None had teeth extracted or preliminary orthodontic treatment. We divided them into two sections; we treated the first group of 33 patients with the Distal Active Concept (DAC), which encourages forward movement and growth of the mandible, and we treated the second group of 31 patients with Extra-Oral Force (EOF) in combination with a full-banded appliance. Comparing the results with cephalometric profile analyses, we found that the soft tissue contour of the lower part of the face showed considerably more sagittal development in the children treated by DAC than those treated by EOF., (© EDP Sciences, SFODF, 2010.)