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Ritschl LM, Heinrich V, Grill FD, et al. Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis. Plast Reconstr Surg Glob Open. 2018;6(7):e1832doi: 10.1097/GOX.0000000000001832.
Ritschl, L. M., Heinrich, V., Grill, F. D., Roth, M., Hedderich, D. M., Rau, A., Wolff, K. D., Bauer, F. X., & Loeffelbein, D. J. (2018). Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis. Plastic and reconstructive surgery. Global open, 6(7), e1832. https://doi.org/10.1097/GOX.0000000000001832
Ritschl, Lucas M, et al. "Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis." Plastic and reconstructive surgery. Global open vol. 6,7 (2018): e1832. doi: https://doi.org/10.1097/GOX.0000000000001832
Ritschl LM, Heinrich V, Grill FD, Roth M, Hedderich DM, Rau A, Wolff KD, Bauer FX, Loeffelbein DJ. Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis. Plast Reconstr Surg Glob Open. 2018 Jul 17;6(7):e1832. doi: 10.1097/GOX.0000000000001832. eCollection 2018 Jul. PMID: 30175012; PMCID: PMC6110680.
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Plast Reconstr Surg Glob Open. 2018 Jul 17;6(7):e1832. doi: 10.1097/GOX.0000000000001832. eCollection 2018 Jul.

Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis.

Plastic and reconstructive surgery. Global open

Lucas M Ritschl, Veronika Heinrich, Florian D Grill, Maximilian Roth, Dennis M Hedderich, Andrea Rau, Klaus-Dietrich Wolff, Franz X Bauer, Denys J Loeffelbein

Affiliations

  1. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
  2. Institute of Medical and Polymer Engineering, Technische Universität München, Germany.
  3. Department of Oral and Maxillofacial Surgery, Helios Hospital Munich West, Teaching Hospitalof Ludwig-Maximilians-Universität München, Germany.
  4. Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany.

PMID: 30175012 PMCID: PMC6110680 DOI: 10.1097/GOX.0000000000001832

Abstract

BACKGROUND: The purpose of this study was to evaluate the stress distribution patterns within the viscero- and neurocranium of neonates during nasoalveolar molding.

METHODS: Finite element models of 3 different healthy neonates at different times of life (date of birth, 4 weeks, and 3.5 months) were generated on the basis of computed tomography scans. A validated workflow, including segmentation, meshing, setting of boundary conditions, and implementation of a bone density-dependent material model, was carried out for each model. A small and a large unilateral alveolar and hard palatal cleft were virtually cut in each model. The stress distribution pattern in each model was then analyzed by using Ansys APDL.

RESULTS: Convergence analysis validated the results. The virtual experiments at the date of birth showed a stress pattern above a previously defined threshold value of 30,000 Pa in the ipsilateral naso-orbital-complex, frontal sinus, and the anterior fossa of the base of the skull, with von Mises values > 35,000 Pa. Stress patterns at the age of 4 weeks and 3.5 months showed reduced von Mises values at < 15,000 Pa.

CONCLUSIONS: Nasoalveolar molding therapy is a safe presurgical treatment modality without significant influence on the viscero- and neurocranium of neonates. Treatment, considering the stress distribution at the naso-orbital-complex and anterior fossa of the base of the skull, should begin in the second week of life, and treatment initiation of preterm infants should be adapted respectively.

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