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Maxillary Changes Following Facial Bipartition - A Three-Dimensional Quantification.

Alexander J Rickart¹, Lara S van de Lande², Eimear O'Sullivan³

¹Department of Oral and Maxillofacial Surgery.

The Journal of Craniofacial Surgery

|March 26, 2021

Summary

This summary is machine-generated.

Children with Apert syndrome undergoing facial bipartition (FB) experience spontaneous dental realignment post-surgery. This dental compensation corrects alignment without compromising surgical outcomes, suggesting a delayed orthodontic approach.

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Area of Science:

Craniofacial surgery
Orthodontics
Pediatric plastic surgery

Background:

Apert syndrome presents with hypertelorism and midfacial hypoplasia, necessitating surgical correction like facial bipartition (FB).
FB involves a midline osteotomy, often using rigid external distraction, which can lead to dental arch changes such as posterior cross-bites and midline diastema.
Postoperative spontaneous realignment of dental arches occurs to varying degrees.

Purpose of the Study:

To quantify dental and skeletal movements following FB in Apert syndrome patients.
To determine if observed dental realignment is due to skeletal relapse or dental compensation.
To assess the impact of these movements on surgical outcomes.

Main Methods:

Retrospective review of Apert syndrome patients who underwent FB.
Analysis of high-quality computed tomography scans (preoperative, immediate postsurgery, postoperative).
3D bone mesh creation and quantification of point-to-point displacements using nonrigid iterative closest point registration and arrow maps.

Main Results:

Arrow maps revealed initial anterior movement of the frontofacial segment, medial orbital rotation, and transverse maxillary divergence.
The bony skeletal position remained largely stable post-surgery.
Primary dentoalveolar relapse was identified as the mechanism correcting dental alignment.

Conclusions:

Spontaneous dental compensation effectively corrects dental alignment after FB in Apert syndrome.
This dental compensation does not compromise the surgical result.
A 6-month waiting period for active orthodontics post-FB may be beneficial to allow for this early compensatory phase.