vývoj a růst čelistí. změny během života. dysplasie tváře ... · nasolabial groove is deep...
TRANSCRIPT
-
Vývoj a růst čelistí. Změny během života. Dysplasie tváře, rozštěpy patra. Zesílená a zeslabená místa obličejového skeletu; lomné linie.
Ivo Klepáček
cle fts
-
Utváření dolní čelisti
cle fts
-
T.F. – fetalweekR - year
cle fts
-
Růstové změny během života after Enlow 1966
II
Expanse střední a přední lebeční jámy
V závislosti na tom se očnice stáčejí mediálně a ventrálně
1:8 1:2cle fts
-
Expansion and growth of the synchondroses and sutures support middle face segments and base parts to year 7.
Postnatal growth
Dislocation down and ventrallySlow to year 15-18.
Dislocation up and ventrallyFast to year 12.
Synchondrosis sphenooccipitalis 17.yearSynchondrosis sphenoethmoidalis after deliveryIntraoccipital synchondroses year 5Sphenoid synchondroses delivery time
after Schumacher 1992
Dislocation ventrallyto year 7.
cle fts
-
FrontalisEthmoidalis
anterior
MaxillarisAntrum
Highmori
8 yr
20 yr
12 yr
1 yr
60 yr
4 yr
"Ostiomeatal unit – functional anddevelopmentalconnection of
sinusesostiomeatal unit"
N. Highmore:Corporis humani disquisitio anatomica; in qua sanguinis circulationem in quavis corporis particula plurimis typis novis ac aenigmatum medicorum succincta dilucidatione ornatam prosecuutus est.Hagai-Comitis [The Hague], 1651.
The sinus was well known to anatomists before Highmore. It had been illustrated by Leonardo da Vinci (1452-1519) and had been noticed by Giulio Casserio (1561-1616)
cle fts
-
Epithelium: keratinizing, continueson inner ret surface as a
multilayered slowly keratinizingepithelium
lamina propria mucosae continuesas submucous layer containingsmall serous or mucous glands
(in soft palate)
cle fts
-
Palate formationand clefts
cle fts
-
Primary palateo (intermaxillary segment) and finalsecondary palate
Palate formation and clefts
cle fts
-
6.5 week
Palatal shelves are vertically oriented firstPalatal shelves are lifting upPalatal shelves (processes) are mutuallyconnected and fuse with primary palatecle
fts
-
Palatal processes are connected togetherabout one week earlierin women in comparison with men
Week 10
cle fts
-
No ability to pucker lipsArticulate, pronounce
Normallu eat and drink
Separation from group of otherchildren
retardation
cle fts
-
Rozštep rtu: - nemožnost uzavřít ústní štěrbinu
cle fts
-
Cantrell pentalogy
Cantrell 1958
five characteristic findings:Omphalocele
Anterior diaphragmatic herniaSternal cleft
Ectopia cordisIntracardiac defect: either a ventricular septal defect or a diverticulum of the left
ventricle
cle fts
http://en.wikipedia.org/wiki/Omphalocele�http://en.wikipedia.org/wiki/Diaphragmatic_hernia�http://en.wikipedia.org/wiki/Sternum�http://en.wikipedia.org/wiki/Ectopia_cordis�http://en.wikipedia.org/wiki/Ventricular_septal_defect�http://en.wikipedia.org/wiki/Diverticulum�http://en.wikipedia.org/wiki/Left_ventricle�http://en.wikipedia.org/wiki/Left_ventricle�
-
In middle Europe – patients with cleft they haveanamnesis of this malformation in family onluy in 20% .Risk for offspings of these patients varies between 4 -
15%.
Very rare are patients with multimalformations – with geneticsyndromes.
Risk in these cases is very high.
Well.known is van der Woude syndrome, where palate cleft appearsrepeatedly (about 80%) , together with fistulas on lower lip.
Genetically ky precedented dangerousness ?cle fts
-
Collinsův syndromMandibulofacialdysostosis (face
hypoplasia)Hypodiferenciation of zygomatic bones,
mandible, eyes oriented down, coloboma of lower eylid, external ear
defects
Autosomal, can bestarted by influence
of retinoid acid
RARE
cle fts
-
DiGeorge syndrome
(third and fourth arch syndrome, Velocardiofacial
syndrome VCFS + concotruncal anomalies face
syndrome CATCH22)Cardiovascular defects
Abnormal faciesThymic hypoplasia
Cleft palate, microstomiaHypocalcemia, Hypertelorism22 chromosome is damaged
Can be initiated by retinoids
1/2500
cle fts
-
Robin syndrome
micrognathiaUnderdevelopment of the 1st arch structures, mandibular hypoplasia,
Micrognathia, cleft palate, glossoptosis (posteriorly placed tongue)
Alteration of the 1st arch, can be caused by oligohydramnion
1/8500
cle fts
-
Van der Woudesyndrom
Hypodiferentiation of skull bones, cleft lip, palate, fistulae in lower lip, hypodontia
About 80 percent probability ofother incidence in the same family
autosomalActivated by regulatory
factor 6 (IRF6)
RARE
cle fts
-
CLEFTSNon fusion of face processes
through developmentCongenital and teratogenic influences(time of critical period and period of
drug influence)
Three critical periods:25.- 35. day isolated lip cleft37.- 53. day isolated palate cleft(shelves damaged)53.-57. day isolated palate cleft(growth of mandible is retarded)
vícefaktorovýProtikřečové látky(phenobarbital, diphenylhydantoin)CytostatikaImunosupresiva, Tetracyklin,Záření
! Preventivně léčit rozštěpy do druhého měsíce těhotenství !
Včas prenatálně diagnostikovat po třetí kritické periodě a zvážit
přerušení těhotenství
20 % – hereditary10 % – outer environment influence
(mother, radiation….)70 % - unknown
DiabetesHypoglykemické stavyEpilepsieStreskortikoidy
cle fts
-
Neinvasive ultrasonography helpsto make diagnosis of lip cleft in
utero. Isolated cleft palate can not be seen.
Third trimester
cle fts
-
Incidence of face clefts during last 30 years
Doc. Peterka: Number affected children varies depending on natality.
From year1965 to1975 was number of defected children increased twotime (120 to 230).
From year1976 up to date number of children with clefts was decreasing.
Perhaps, it depends on lower and lower number of childbirths.
cle fts
-
Year incidence of newborns with facialclefts is relatively stabvle and varies
about dlong aritmetic mean 1.7 per 1000 childbirths.
cle fts
-
Following cleftposition:
First group: lip clefts (isolated orcombined with palate cleft)
Second group: isolated palateclefts.
cle fts
-
cheiloschisis
1/100080% males
Unilateral cleft lip
Incidence increases with maternal age
4-7-17% cle fts
-
cheilognathouranostaphyloschisis
Cleft lip, jaw and both the palati
1/2500cle fts
-
Cheilognatho-uranoschisis unilateralis
Unilateral lip, jaw andpalate cleft
1/2500
cle fts
-
Cheilognatho-uranoschisis bilateralis
Bilateral cleft lip, jaw andpalate
1. Columella – skin segment betweennostrils.- shortened. 2. Prolabium – connects columella andphiltrum – swollen.3. Premaxilla – narrow and small; separated from maxilla.
1/2500
cle fts
-
Palatoschisis(uranoschisis)
Isolate cleft palate
Incidence increases with maternal age
2-7-15%
1/250067% females
cle fts
-
Cleftoverviewcle
fts
-
operation
1) Closure of cleft lip – as fast as possible, (suckling baby age), All lip structurs can be separated and connected together by sutures.
2) Closure of cleft palate – indicated for age 1 – 3 year, Mucous and muscular flaps of soft palate are pushed together
3) Osteoplastic procedure on defected alveolus – indicated in age 8 – 11 year.
Osseous autotransplat is applied into alveolus and oronasal opening isclosed by soft tissues from surrounding areas (usually to the end ofpubertal period.
cle fts
-
Před a po operaci
Before and after surgical treatment
cle fts
-
Postoperative Torus palatinus
(Palatal swelling)
cle fts
-
Cleft palate before surgery, age 0 months 15 days.
Cleft palate after surgery, age 2 years 12 days.
Cleft palate after surgery, age 5 months 21 days.
Cleft palate after surgery, age 2 years, 10 months28 days. Healing is complete.
Cleft lip before surgery, age 2 months 8 days.
Cleft palate before surgery, age 2 months 8
days.
Cleft lip after surgery, age 5 months 22 days.
Cleft palate after surgery, age 5 months 22 days.
Recidiva
Recurrencecle fts
-
Hypofunkceměkkého patraHypofunctionof soft palate
Zvedání patra selhává
Failure of soft palatelifting
cle fts
-
Chirurgical and dental care isprolongated from birth to year 18.
cle fts
-
6. a 7. týden
Philtrum, sulcus nasolacrimalis,saccus lacrimalis, faciei, maxillae, nasus externus cle
fts
-
Nasolabial groove
Oblique face cleft
Nasolabial groove is deep and nasolacrimal duct isfree
cle fts
-
cle fts
-
Fissura labii mediana
Obvykle je doprovázena holoprosencefalií
holoprosencephalia
cle fts
-
holoprosencephaliaHypodiferenciace čelní části hlavy včetně mozkucle
fts
-
Face clefts Rare. Probably hereditary influence ?. Unknown etiology. Characteristic following Tessier :
1. Cleft relates to disturbancies of soft even hard facetissues.
2. Cleft appears only in some regions.3. Fully developed cleft can be followed by anomalies of
skull basis. One of affected aread is orbit. Frequency of orbit clefts decreases in direction
counter clockwise.
cle fts
-
Masticatory pressure buttresses (Traiectoriae maxillae on boththe sides - canine, zygomatic, pterygoid. Other, dorsal buttress – grows from the mastoid process and from the area offoramen magnum (foramen occipitale magnum).
Frame-like construction of skullButtressesin facialskeleton
Three buttresses allow face to absorb force Nasomaxillary
(medial) buttress Zymaticomaxillary
(lateral) buttress Pterygomaxillary
(posterior) buttress
cle fts
-
Strips ofcompact
bone tissuesin the human
skullfollowingDeffez 1966
Patrová deska
Palatal plate (desk)
cle fts
-
Transferenceof load in
facialskeleton
cle fts
-
Trajectoriesin the humanskull base;
Interior view
followingDeffez 1966
cle fts
-
Pressureand tensiontrajectories
in mandible
cle fts
-
Transfer of pressure
and loadin
mandible
after Lang 1995
cle fts
-
Trabeculaeseen in
mandible
after Lang 1995
cle fts
-
cle fts
-
Fractures after Le Fort (René Le Fort 1902)
What´s broken:
• Medial wall of orbit
• Lateral wall of orbit to frontozygomatic suture
• Pterygoid process
• Basal part of nasal septum
• zygomatic arch
cle fts
-
Le Fort IGuérin´s fracture
Subzygomatic
Le Fort I fractures: (horizontal) A fracture of the maxilla immediately above the teeth and palate.
cle fts
http://en.wikipedia.org/wiki/Teeth�http://en.wikipedia.org/wiki/Palate�
-
Le Fort IIPyramidal,
central, upper subzygomatic
Le Fort II fractures: (pyramidal) The result of a blow to the lower or mid maxilla.
cle fts
-
Diagnosis Lefort II and III
Bilateral periorbital edema & ecchymosis
Step deformity palpated infraorbital & nasofrontal area
CSF rhinorrhea Epistaxis
cle fts
-
Le Fort IIISuprazygomatic
fracture
Le Fort III fractures: (transverse) Also called craniofacial separation, the result of impact to the nasal bridge or upper maxilla.
Nasal root, medialorbital wall. Inf. orbital notchLat. orbital wallinf. Orbital notchBasis of pterygoidprocessZygomatic arch
cle fts
http://en.wikipedia.org/wiki/Craniofacial�
-
Trakční (tahové) a tlakové linie
CondyleUpper
Lower neck
Retromolar (angular)
Through canine,
through mental region
Lomné linie dolní čelisticle
fts
-
Fossa infratemporalisInfratemporal fossaSpatium pterygomandibulare
mm. pterygoideiFossa infratemporalis ossea
Fossa pterygopalatinacle fts
-
Sup.:Ala major ossis
sphenoidalisMed.:
Lamina medialisprocessus pterygoideus +
pharynxVentr.:
Tuber maxillaeLat.:
Ramus mandibulaeDors.:
Septum styloideum
Stěny infratemporální jámyWalls of the infratemporal
fossacle fts
-
SpatiumparapharyngealeParapharyngeal space
• Deep cevical space
• Looks like pyramid on top; basis – skullbase, top – hyoid bone
• Parts: prestyloid andretrostyloid spaces
cle fts
-
Styloidní septum
Styloid septum
cle fts
-
Superficial parts:Pterygomandibular spacepterygoidei mm. and sp. between them
Vrstvy layers
cle fts
-
cle fts
-
cle fts
-
cle fts
-
Bichatův polštář kříží ductus parotideusBichat´s fat pad is crossed by parotid duct
cle fts
-
Fossa infratemporalis„hluboká vrstva“
Infratemporal fossa“deep layer“
Větve V3Mandibular
branches
Hluboké části:Fossa infratemporalis osseaFossa pterygopalatina cle
fts
-
Fossa infratemporalis„Povrchová vrstva“
Infratemporal fossa“superficial layer“
Tepny a žilní pleteněArteries and plexiform-like veins
cle fts
-
Plexus pterygoideusPterygoid plexus
cle fts
-
Pterygoid venous plexus
and its tributaries:n superior ophtalmic p inferior ophtalmic
n infraorbital vein to pterygoid plexus
(through foramen ovale –rete)
r deep facialu buccal
inferior alveolar vein
... retromandibular vein h maxillary veins
cle fts
-
cle fts
-
Arteria maxillaris –větve pars retromandibularis
• a. auricularis profunda• a. tympanica anterior• a. meningea media
• a. alveolaris inferiorcle fts
-
Arteria maxillaris – větve pars pterygoideacle
fts
-
Arteria maxillaris – větve odstupující
z pars pterygopalatina
• a. alveolaris superior posterior• a. infraorbitalis
• a. palatina descendens: a. palatina major et minores
• a. canalis pterygoidei• a. sphenopalatina:
a. nasales posteriores laterales et nasales posteriores septalescle
fts
-
Fossa pterygopalatinaPterygopalatine fossa
(sphenopalatine)
Pterygoid canal
Greater palatine canal
Sphenopalatine foramen
Inferior orbital fissure
Round foramencle fts
-
cle fts
-
cle fts
-
Fossa pterygopalatina –preparace z dutiny nosní
Fossa pterygopalatina dissected from the nasal
cavity
cle fts
Snímek číslo 1Utváření dolní čelistiSnímek číslo 3Snímek číslo 4Snímek číslo 5Snímek číslo 6Snímek číslo 7Palate formation and cleftsSnímek číslo 9Snímek číslo 10Snímek číslo 11Snímek číslo 12Snímek číslo 13Cantrell pentalogy�Cantrell 1958Snímek číslo 15Collinsův syndromDiGeorge syndrome�(third and fourth arch syndrome, Velocardiofacial syndrome VCFS + concotruncal anomalies face syndrome CATCH22)Robin syndromeVan der Woude syndrom�Snímek číslo 21Snímek číslo 22Snímek číslo 23Snímek číslo 24cheiloschisischeilognathouranostaphyloschisisCheilognatho-�uranoschisis unilateralis Cheilognatho-uranoschisis bilateralisPalatoschisis�(uranoschisis)Snímek číslo 30operationSnímek číslo 32Snímek číslo 33Snímek číslo 34Hypofunkce měkkého patra�Hypofunction of soft palateSnímek číslo 36Snímek číslo 37Oblique face cleftSnímek číslo 39Fissura labii medianaholoprosencephaliaFace clefts�Buttresses in facial skeletonStrips of compact bone tissues in the human skull� following �Deffez 1966Transference of load in facial skeletonSnímek číslo 46Pressure and tension trajectories in mandible�Snímek číslo 48Trabeculae seen in mandible� Snímek číslo 50Snímek číslo 51Snímek číslo 52Snímek číslo 53Diagnosis Lefort II and IIISnímek číslo 55Lomné linie dolní čelistiSnímek číslo 57Snímek číslo 58Snímek číslo 59Snímek číslo 60�Snímek číslo 62Snímek číslo 63Snímek číslo 64Snímek číslo 65Snímek číslo 66�Snímek číslo 68Pterygoid venous plexus and its tributaries:�n superior ophtalmic � p inferior ophtalmic� n infraorbital �vein to pterygoid plexus (through foramen ovale – rete) � r deep facial� u buccal� inferior alveolar vein� � ... retromandibular vein � h maxillary veins� Snímek číslo 70��Snímek číslo 73��Greater palatine canalSnímek číslo 76�Snímek číslo 78