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Book cover - Craniofacial anomalies: surgical-orthodontic management

 

CRANIOFACIAL ANOMALIES: SURGICAL-ORTHODONTIC MANAGEMENT

MEAZZINI M.C. – BOZZETTI A. – BRUSATI R. – MAZZOLENI F. – GARATTINI G. – FELISATI G. – LALATTA F. – REZZONICO A.

196 pages • 617 color illustrations

ISBN 978-88-7572-112-1

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Prezzo di copertina 160,00 €

Se acquista online, sconto internet -15%

136,00 €

The Authors
Foreword
Preface
Introduction
Index

 

The Authors

 

Maria Costanza Meazzini

Specialized in Orthodontics and Dento-Facial Orthopedics at Harvard University, Boston. Master in Medical Sciences and Oral Biology in 1995 at Harvard University, Boston MA. Fellowship in Craniofacial Orthodontics, at University of Illinois at Chicago, Chicago, IL in 1997. Dr. Meazzini is orthodontic consultant for craniofacial anomalies for the Regional Center for Cleft Lip and Palate, San Paolo Hospital (director: Prof. Brusati) and for the Department of Maxillo Facial Surgery, San Gerardo Hospital, Monza (director: Prof. Bozzetti). She is Adjunct Professor in Pre-surgical Orthodontics and Orthodontics for Craniofacial Anomalies, both for the Postdoctoral residency in Maxillofacial Surgery, University of Milano and Milano- Bicocca and for the Postdoctoral Residency in Orthodontics, University of Milano.

 

Roberto Brusati

Born in in 1941, graduated in Medicine in Milano in 1965. Specialized in Dental Medicine and in Plastic and Reconstructive surgery. Director of the Department of Maxillo-Facial Surgery, University of Parma in 1980. Has founded and directed since 1987 the first Postgraduate Residency program in Maxillo-Facial Surgery. He was requested as
Full Professor by the University of Milano in 1992. Henceforth he has been Full Professor and Head of the Department of Maxillo-Facial Surgery of San Paolo Hospital, Milano. Has founded the regional Center for the treatment of Cleft lip and Palate and Craniofacial anomalies. Author of over 200 scientific papers in craniofacial and maxillafacial surgery.

 

Alberto Bozzetti

Graduated at Parma Medical school. Specialized in Dental Medicine and in General Surgery. Is Full Professor and Head of the Department of Maxillo-Facial Surgery at San Gerardo Hospital, Monza, University of Milano-Bicocca and directs the Unit of the Azienda Ospedaliera Niguarda Cà Granda, Milano. He is Director of the Postgraduate Residency program in Maxillo-Facial Surgery, University of Milano-Bicocca.

 

Fabio Mazzoleni

Born in Bergamo in 1965. Graduated in Medicine in Milano in 1992. Specialized in Maxillo-Facial Surgery in 1997 and in Microsurgery and Experimantal Surgery in 2000. Attending physician in the Department of Ma- xillo-Facial Surgery, San Gerardo Hospital, Monza (Head: Prof. E.P. Caronni till 1999. Since 1999 Prof. A. Bozzetti). His main fields of interest and research are: craniofacial surgery for congenital anomalies, orthognathic surgery, distraction osteogenesis, trauma surgery. Has published and presented scientific works nationally and internationally.

 

Giovanni Felisati

Born in Milano in 1956. Specialist in Ear Nose and Throat Surgery and in Cervical-Facial Pahtology, Specialist in Au- diology. Associate Professor in ENT, University of Milano. Head, Department of ENT and Head and Neck Pathology, San Paolo Hospital, Milano. Director of the Postgraduate Residency Program in Audiology and Speech pathology, University of Milano. Author of over 200 scientific publications.

 

Giovanna Garattini

Associate Professor in Dental Pathology – University of Milano (HYPERLINK “http://www.unimi.it” www.unimi.it), Professor in Orthodontics for the School of Dental Medicine, School of Hygene, School of Speech therapy and for the postgraduate Specialty program in Maxillofacial Surgery and in the Postgraduate Program in Orthodontics and dento- facial orthopaedics, University of Milano. Director of the department of Orthodontics (HYPERLINK “http://www.ao- sanpaolo.it” www.ao-sanpaolo.it) and Coordinator of the Regional Centre for Cleft Lip and Palate, San Paolo Hospital. Author of over 170 scientific papers in orthodontics with special interest in craniofacial growth, cleft lip and palate patients, biomechanics, combined surgical/orthodontic treatment protocols.

 

Faustina Lalatta

Degree in Medicine at the university of Milan (1981), specialization in Medical Genetics at the University of Rome (1983) and Pediatrics at the University of Milan (1987). Permanent position as Clinical Geneticist since 1990 at the Istituti Clinici di Perfezionamento in Milan. Since 2004 Head of the Clinical Genetics Unit at Fondazione Cà Granda Ospedale Maggiore Policlinico in Milan. Main areas of interest: genetic dysmorphology, prenatal diagnosis, genetic screening, genetic education, access and quality of genetic services in preconception care, ethical and legal issues.

 

Angela Rezzonico

Graduated in Speech Therapy at University of Genova (2007). Technical diploma in Ortophony at University of Milano in 1981. Since 2006 she is Adjunct Professor for the postgraduate specialty program in Maxillofacial Surgery.
Since 2001 she is Consultant for Speech Therapy at the Regional Centre for Cleft Palate S. Paolo Hospital. Has been in private practice for speech therapy and psychology practice for speech language disorders since 1981.

 

Foreword

 

Three years ago I asked Dr. Maria Costanza Meazzini if she would consent to write a monograph on the orthodontic treatment of craniofacial anomalies, which should have been included as number 30 in the orthodontic series that I have had the honor of coordinating for the past 20 years for the publisher Dr. Martina.

She gladly accepted, and in order to treat more fully the topic of surgical-orthodontic coordination I asked her, to talk about it with Prof. Brusati, with whom she had been collaborating for almost 20 years.

I owe to her enthusiasm, passion and expertise if, with ease, we got Prof. Brusati’s consent.

I inserted on the back cover the working title, to be published as a monograph in the series, and I followed, during the subsequent months, the development of the manuscript.

Prof. Brusati and Dr. Meazzini sensed immediately that it was necessary to give a complete and organic imprint to this work, and suggested to add to the orthodontic surgical coordination other aspects of the interdisciplinary treatment of craniofacial anomalies, such as speech therapy, genetics, ENT, while involving the whole team in the completion, not only of the part about cleft lip and cleft palate but also of the subsequent parts of the text.

Again, thanks to the tireless work and organizational capabilities of Dr. MC. Meazzini, this manuscript was slowly composed and gradually took a wonderfully organic shape.

I also owe to the great friendship which binds me to Prof. Alberto Bozzetti, his willingness to write, always with Dr. MC. Meazzini, the chapter on surgical treatment of cranio-facial-synostosis and to encourage his co-worker, Dr. F. Mazzoleni, to write the third surgical chapter on hemifacial microsomia and on the syndromes of the first and second branchial arches When I finally read the whole text, I realized the vastness and completeness of the work, the value of its unique, irreplaceable and important documentation. Therefore, I went to Bologna to Dr. Martina, and told him that I renounced to insert the book in my orthodontic series because it was a work that deserved a release as a separate book.

The Publisher, as ever enlightened and far-sighted, not only shared my enthusiastic proposal, but always with his great philanthropy and generosity, later accepted the suggestion to print it in English.

The result is this magnificent work, which seals the amazing story of a young graduate in Medicine and Surgery, who, in the mid 60’s was already so passionately interested about these difficult diseases, that he chose to learn from the best Italian and foreign teachers: G. Sanvenero Rosselli, to L. Rusconi, to Profs. A. Reherman (Dusserdorf and M. Perko Zurich and later with Prof. Delaire Nantes etc..), refining and improving the various surgical techniques he had learned over time. The fact that his passion had deep roots is clearly demonstrated by his very first scientific work, which was entitled “Epithelial fusion and Mesenchymal consolidation in palate embryogenesis (J Sumicr. Cytol 1969)”!

With tenacity and mittel European perseverance Prof. Brusati continued, not only his research, but persisted to refine, improve, alter, replace his surgical techniques in a never ending attempt to improve the facial features of his patients. He kept on working to provide, not only Quality and Excellence and Stability of long-term results, but also to reduce the time, number of interventions, long term care and physical and psychological stress for both the young patients and their parents.

He taught and not only raised close to him excellent surgeons, but also developed a complete team of excellency and quality.

Once again we can say that in these 50 years Brusati was able to give what the great German philosopher Karl Jaspers called the true face of medicine “Wissenschaft und Humanität”; Science and Humanity!

I had the good fortune to know him almost immediately, to work with him with my private clinical cases, but, in particular it was he, together with the late Professor Umberto Gennari to ask for me to Chair the Orthodontic Department in Parma and then encouraging me to move from Parma to the University of Cagliari. Brusati was the first to understand that only through an intense collaboration with the specialist in orthodontics, the best results, not only for craniofacial anomalies, but for all the orthodontic surgical patients, could be achieved.

He even dedicated study and application to diagnostic and clinical orthodontic procedures and philosophies, becoming an expert also in my field of expertise.

In particular, he has later found in Dr. M. Costanza Meazzini, a specialist with his same gifts of profound humanity and humility which, associated to her great competency in the field, acquired during her long training in Orthodontics and Dento-Facial Orthopaedics at Harvard University in Boston and her fellowship in Craniofacial anomalies at University of Illinois at Chicago, and with her continuous learning and constant research in the field, have allowed a synergy and a unique symbiosis with her and the whole team.

Prof. Brusati was able to finish his project by creating a teamwork and taking care of all inter-and multidisciplinary aspects and accepting sometimes with incredible humility, a sign of great intelligence, to modify his surgical techniques at the suggestion of other specialist. Finally, he was able to teach and prepare his co-workers and lead them to the top of their academic career.
Educating comes from the Latin “e-ducere” knowing to extract the best from your own students, and this etymology Prof. Roberto Brusati has been able to effectively combine and achieve, always showing all of the members of his team his great esteem and mutual aid. “Vera Scientia est Celare scientiam”, “True Science is to Conceal Science”! The true scientist is one who knows how to conceal his knowledge.

His simplicity and his reserve have always demonstrated this attribute, and he was able to transmit this exceptional quality to his pupils.
I warmly thank him because, to me, he was always a master of science and of life and I’m glad I was able to inspire and accomplish this work, which will continue to be, in time, a very useful tool for all professionals working in the field and a testimony of a life dedicated to continuous research and willingness to change for the good of patients.

A deep heartfelt thanks to Costanza Meazzini, because with her passion, enthusiasm, skill, great charm and simplicity, she has been able to produce and coordinate this work with her teacher and all the co-workers in the team. I thank her for the long and tenacious dedication to the work with myself and with the editorial manager, who took care of every detail, especially for the iconography, making the manuscript more valuable and clinically useful. Then again, a particular thanks for the preparation of the English translation of the book, after having suggested the idea.

Special thanks to Prof. Alberto Bozzetti, not only excellent collaborator for decades of Prof. Brusati, but also my consultant in the past 10 years in Orthognathic Surgery.
Thanks again to all the other co-authors, who, with their specific expertise, have completed the various clinical aspects described.

To the Editor Dr. Alfredo Martina my praise and my gratitude for having published this work which is certainly the flagship of his long and already valuable publishing collection.

PROF. DAMASO CAPRIOGLIO
Former Full Professor of Orthodontics
Professor of Ethics
University of Parma
Senior Member of the Italian Orthodontic Specialists

Preface

 

The treatment of congenital craniofacial deformities is extremely complex. Our aim should be an ideal morphological and functional correction, although, unfortunately, our results are still far from perfect.

Interdisciplinary cooperation between the surgeon and the orthodontist is fundamental in order to reach this objective, and it is much more challenging than the usual collaboration which is routinely needed in the treatment of dento-facial deformities.

In the latter case most situations are standardized, each with its peculiar problem and each with its well coded orthodontic and surgical treatment strategies.

Different is the case of congenital craniofacial malformations, where each deformity is radically different from the other at start. To this we need to add the effect of a primary treatment which might have had different results from case to case.

Different amounts of scar tissue might be present, lip and tongue muscular function might be differently hindered, teeth might deformed or missing, maxillary growth might be variably impaired or intrinsically poor.

These are all issues which it make it impossible to standardize the treatment of these patients and impose an individual treatment plan with a close collaboration between surgeon and orthodontist, who need to discuss the options together with the patients.

In this precious, and I must say, unique volume, devoted to this very peculiar pathology, the reader may find the bases which allow to address with a rational approach, the best solution for each child with a craniofacial deformity.

PROF. ROBERTO BRUSATI

Introduction

 

A Craniofacial malformation is an anomaly of embryonic development that results in a serious impairment of the normal anatomy of the skull, the jaws and the adjacent soft tissues. Three-quarters of the malformations diagnosed at birth fall in the category “craniofacial”. The most common facial malformations are cleft lip and cleft palate.

Less frequent are the syndromes of the I and II branchial arches, malformations that predominantly affect the mandible and the adjacent soft tissues, symmetrically or asymmetrically, such as hemifacial microsomia (Oto-mandibular Syndrome) or Franceschetti syndrome (or Treacher Collins).

Even more rare are the forms more accurately called” craniofacial”, that primarily involve the midface and the skull, called cranio-facial-synostosis, such as Apert Syndrome (1 born in 100,000) or Crouzon syndrome (1 in 25,000).

Then there are even more rare syndromes, such as Beckwith Wiedemann syndrome, Achondroplasia, Oro-facialdigital syndrome, which the orthodontist is required to know in depth, as involving the jaws, they have a strong involvement in orthodontics.

The birth of a child with a facial deformity is a devastating event for most parents, who often have never seen or heard about similar malformations. For some parents it is very difficult to accept the deformity of the child because it involves the face making the child appear completely different from all the others. Feelings of rejection, guilt, and anxiety gradually develop.

Internet as a whole, although sometimes a useful tool to gather information, can be a source of unfounded fears for parents already scared. It is fundamental therefore, that since the diagnosis, the family comes into contact with health providers that can reassure them and inform them about the possibilities and limits of treatment.

This is how, in the 50s, the concept of the craniofacial team was born. The first craniofacial team was founded by Samuel Pruzansky,a great orthodontist in Chicago Children with craniofacial deformities require a very detailed and specific medical support.

Therefore, the geneticist, the surgeon, the neonatologist, the pediatrician, the neurosurgeon, the ENT, the orthodontist, the ophthalmologist, the speech therapist and speech pathologist, and many other specialists who will take care of these patients should all have a very specific expertise in the field and a habit of close collaboration, because the problems of these patients often differ substantially from those of the so-called normal patients.

Through a multidisciplinary treatment by these different specialists, a child affected by a craniofacial malformation can, nowadays, achieve results which could not have been hoped for, only a few years ago.

The orthodontist is only one of the many specialists within the craniofacial team, playing a role, albeit not of primary importance, which should necessarily be coordinated with the surgical treatment, speech therapy and other treatments needed by the child. Only in this manner we are able to provide a real service to the patient and the burden of care of these children can be significantly reduced.

Index

 

INTRODUCTION

PART 1

CLEFT LIP AND PALATE

1 GENETICS of CLP (F. Lalatta)

2 Embryological development in CLP and clinical features (M.C. Meazzini)

3 Craniofacial growth in CLP (M.C. Meazzini)

4 Surgical treatment of CLP (R. Brusati)

5 Orthopaedic and orthodontic treatment of CLP (M.C. Meazzini)

6 Protocol for the vertical intrusion of the premaxilla in BCLP (M.C. Meazzini)

7 Speech therapy in CLP (A. Rezzonico)

8 ENT treatment in CLP (G. Felisati)

PART 2

CRANIOFACIAL SYNOSTOSIS

9 GENETICS OF craniofacial synostosis (F. Lalatta)

10 Embryological development, craniofacial growth and clinical features in CFS (M.C. Meazzini)

11 Surgical treatment of CFS (R. Bozzetti)

12 Orthodontic treatment of CFS (M.C. Meazzini)

PART 3

HEMIFACIAL MICROSOMIA AND I AND II BRANCHIAL ARCH SYNDROMES

13 GENETICS OF I and II branchial arch syndromese and embryological development (F. Lalatta)

14 Clinical features in I and II branchial arch syndromes (M.C. Meazzini)

15 Craniofacial growth in I and II branchial arch syndromes (M.C. Meazzini)

16 Surgical treatment of I and II branchial arch syndromes (F. Mazzoleni)

17 Orthodontic treatment of I and II branchial arch syndromes (M.C. Meazzini)

18 Organization of craniofacial centers (G. Garattini)