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Case Review: Klippel-Feil Syndrome
Harvey Levy, DMD, MAGD
ACADEMY OF GENERAL DENTISTRY
JUNE 27-28, 2013
Klippel-Feil
Syndrome
Seth W.
age 20
Characteristics of KFS
§ short neck
§ low hair line
§ restriction of neck motion
§ congenital fusion of at least two cervical
segments.
Associated Abnormalities:
§ scoliosis
§ spina bifida
§ anomalies of the kidneys and the ribs
§ cleft palate
§ respiratory problems
§ heart malformations
as well as . . .
Abnormalities of:
§ head and face,
§ skeleton,
§ sex organs,
§ muscles,
§ brain and spinal cord,
§ arms, legs, and fingers.
Seth W., First dental visit at age 5, 1990
§ Klippel-Feil Syndrome
• Heart murmur
• Deaf
• Patent ductus arteriosis
• Hypospadias
• Spinal fusion
Hospital out-patient OR 1-23-06
§ Pre-op Dx
§ Treatment
§ Follow-up
§ Special considerations:
• Anesthetic risk of Nasal intubation
• Multi-disciplinary dental care
§ Tips and tricks
Anesthesiologist communicates with
Seth via interpreter
Seth signs back to anesthesiologist via
interpreter
Seth leaves pre-op, tells parents “Live
Long and Prosper”
Old pan: 8-5-98 Pan showing third molars: 11-2-05 In OR getting ready to intubate Preparing for nasal intubation Preparing for nasal intubation
Preparing for nasal intubation Preparing for nasal intubation Nasal tube in place Nasal tube and drapes Nasal tube, drapes, throat pack
Different Case: Teeth #9, 10 decayed and fractured
Teeth #9, 10 palatal view Teeth 9, 10, 19 decayed and fractured Ankyloglossia
Intraoperative intraoral Ergonom-x self-
developing films
Taking X-rays in the OR Develop Ergonom-x radiographs in OR Periapical x-ray teeth #9, 10 pre-op
Periapical x-ray teeth #9, 10 pre-op Periapical x-ray tooth #19 pre-op Root canal tooth #9 Root canal tooth #9 Final films
#9 root canal, core, & crown prep done Crown prep #19 completed Crown impressions teeth #9, 10 Making temporary crowns Temporary crowns #9, 10 in place
Mandibular lingual frenum Mandibular lingual frenectomy Extracting 4 impacted third molars
4 third molars extracted 4 third molars extracted ted
Opposite view
Seth is extubated After extubation, breathing on his own
with oxygen mask
Seth in post-op with anesthesiologist
2 Weeks later…
Crowns
#9,10,19
on model
Crowns #9, 10, 19 on model
Crowns #9, 10, 19 on model Prepared tooth #19 prior to crown try-in Crown #19 being cemented Crown #19 after cementation Prepared teeth #9, 10 prior to crowns
try-in
Prepared teeth #9, 10 prior to crowns
try-in
Crowns #9, 10 cemented Crowns #9, 10 cemented Crowns #9, 10 cemented Crowns #9, 10 smiling
Seth & Dr. Levy smiling Seth Williams - later 2008
Seth Williams - later 2011
Seth Williams - later 2013
Klippel-Feil Syndrome?
Points we discussed?
Incorporating techniques?
Other aspects?
Any questions about:
What is your take-home
‘pearl’ from this?