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OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.
Subject(s)
Humans , Child , Adolescent , Cleft Palate/surgery , Cleft Lip/surgery , Retrospective Studies , Cancellous Bone , Treatment Outcome , Alveolar Bone Grafting/methods , Bone Transplantation/methodsABSTRACT
Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.
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Humans , Adult , Alveolar Bone Grafting/methods , Cleft Lip/surgery , Cleft Palate/surgery , Treatment Outcome , Nose/abnormalities , Bone Transplantation/methodsABSTRACT
Objective:To evaluate the short time outcome about repairing of lateral incomplete cleft lip with two different treatments: new rotation advancement technique and Tennison technique.Methods:Twenty-seven cases of lateral incomplete cleft lip were repaired by the two different treatments, and 12 indexes were employed to evaluate the short time outcome of post-operation.Results:All the patients who were treated with the new rotation advancement technique and Tennison technique in this study obtained satisfactory lip and nasal symmetry immediately. There was no significant difference between the two techniques in the treatment of the patients with unilateral incomplete cleft lip.Conclusions:Though the new rotation advancement technique does not show the obvious improvements about repairing of lateral incomplete cleft lip, invisible incision and keeping the nostril sill will definitely benefit the patients because of reducing the risk of more scars.
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Normal mammalian secondary palate development undergoes a series of processes, including palatal shelf (PS) growth, elevation, adhesion and fusion, and palatal bone formation. It has been estimated that more than 90% of isolated cleft palate is caused by defects associated with the elevation process. However, because of the rapidly completed elevation process, the entire process of elevation will never be easy to clarify. In this article, we present a novel method for three-dimensional (3D) reconstruction of thick tissue blocks from two-dimensional (2D) histological sections. We established multiplanar sections of the palate and tongue in coronal and sagittal directions, and further performed 3D reconstruction to observe the morphological interaction and connection between the two components prior to and during elevation. The method completes an imaging system for simultaneous morphological analysis of thick tissue samples using both synthetic and real data. The new method will provide a comprehensive picture of reorientation morphology and gene expression pattern during the palatal elevation process.
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Objective:To explore the sensitivity of the normal population to nasolabial subunits.Methods:From 2016 to 2017, we took frontal photos of 25 (20 to 40 years old) people with basically normal nasolabial subunits in West China Hospital of Stomatology. The lip subunits were adjusted at 1.1, 1.2, and 1.3 times magnification or translation to obtain photos of different degrees of malformation of the nasal and lip subunits. A total of 189 young healthy people [96 males, 93 females; age (20.00±1.32) years old] without correction surgery and no maxillofacial deformities were selected to judge the facial aesthetic visual effect of their vision on the nasolabial subunit.Results:The peak sensitivity of nasolabial subunits is the nostril symmetry and columella deviation followed by lip symmetry.Conclusions:Young healthy people have high aesthetic visual effects on nostril symmetry and nasal column translation facial translation, average facial visual effects on lip symmetry and the lowest facial aesthetic visual effects on lip peak symmetry.
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Objective@#To introduce the application of muscle reconstruction torque balance theory in the new rotating advancement method, and to evaluate the postoperative effect of this method on the nasal lip symmetry of patients with unilateral cleft lip.@*Methods@#A total of 62 patients with unilateral cleft lip were treated with two-dimensional radiography of posterior anterior position and mandibular chin position before, immediately and one-year follow-up. Five indexes representing the symmetry of lip and nose were measured by photoshop software. T test was used to compare the measurement results of each angle or distance index at different times. P<0.05 showed that there was significant difference between the two groups.@*Results@#All the patients who were treated with the technique described in this study obtained satisfactory lip and nasal symmetry immediately and one-year follow-up.@*Conclusions@#The new theory of oral muscle strength balance is a new breakthrough on the basis of the application of muscle reconstruction. It is suitable for the primary repairment of unilateral lip, and good results have been obtained.
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The RASopathies are a group of syndromes that have in common germline mutations in genes that encode components of the RAS/mitogen-activated protein kinase (MAPK) pathway and have been a focus of study to understand the role of this pathway in development and disease. These syndromes include Noonan syndrome (NS), NS with multiple lentigines (NSML), neu-rofibromatosis type 1 (NF1), Costello syndrome (CS), cardio-facio-cutaneous (CFC) syndrome, neurofibromatosis type 1-like syndrome (NFLS) and capillary malformation-arteriovenous malformation syndrome (CM-AVM). These disorders affect multiple systems, including the craniofacial complex. Although the crani-ofacial features have been well described and can aid in clinical diagnosis, the dental phenotypes have not been analysed in detail for each of the RASopathies. In this review, we summarize the clinical features of the RASopathies, highlighting the reported craniofacial and dental findings.
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Objective · To observe the effects of custom made fiber posts on the fracture resistance of young permanent teeth treated with calcium hydroxide for different time. Methods · Forty-five extracted human young permanent teeth (premolar) were selected and randomly assigned to 9 groups.One group was the control group and the rest 8 groups were treated with conventional root canal preparation. Of these 8 groups, 4 groups (F Ⅰ , F Ⅲ , F Ⅵ ,FⅨ ) were restored by custom made fiber posts after being treated with calcium hydroxide for 1, 3, 6, and 9 months respectively, and other 4 groups (C Ⅰ ,CⅢ , C Ⅵ , C Ⅸ ) were not restored by custom made fiber posts. All samples underwent fracture strength tests and their fracture modes were analyzed for the possibility of second repair. Results · The fracture load was decreased with the treatment time after being treated with calcium hydroxide for 1 month (P<0.01). The fracture loads in groups restored by custom made fiber posts were increased after being treated with calcium hydroxide for 6 and 9 months (P<0.05, P<0.01). After being treated with calcium hydroxide for 1 month, groups restored by custom made fiber posts were likely to have fracture modes that facilitate the second repair as compared with groups not restored by custom made fiber posts (P<0.05). Conclusion · The restoration by custom made fiber posts can increase the fracture resistance of young permanent teeth treated with calcium hydroxide for medium and long term ( ≥ 1 month).
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Objective To analyze the pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage (sICH) in intensive care unit (ICU).Methods The clinical data of 110 patients with sICH admitted in ICU during January 2015 and February 2017 were collected.Patients were divided into hospital-acquired pneumonia group (HAP group,n =66) and non-HAP group (n =44).Multivariate Logistic regression was used to study the risk factors of HAP,and pathogen distribution and drug susceptibility were analyzed.Results Multivariate Logistic regression demonstrated that long-term mechanical ventilation (OR =1.028,95％ CI 1.012-1.044,P ＜ 0.01),lower score of glasgow coma scale (GCS) (OR =1.550,95％ CI 1.148-2.093,P ＜ 0.01),prolonged hospital stay (OR =1.131,95％ CI 1.046-1.224,P ＜0.01) and underlying diseases more than two forms (OR =9.793,95％ CI 1.012-1.044,P ＜ 0.01) were the independent risk factors of HAP,while high plasma albumin level was protective factor for HAP (OR =0.897,95％ CI O.811-0.992,P ＜ 0.05).One hundred and eighty-three bacterial strains were isolated from 66 patients,the top 4 pathogens were Acinetobacter baumannii (28.96％,53/183),Klebsiella pneumonia (15.85％,29/183),Pseudomonas aeruginosa (13.11％,24/183) and Staphylococcus aureus (12.02％,22/183).Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were highly resistant to the majority of antibiotics,some of which even reached 100％.Staphylococcus aureus showed high resistance to macrolides,fluoroquinolones and β-lactam antibiotics.Conclusions There is high incidence of HAP in patients with sICH,and the pathogenic bacteria are mainly gram-negative bacteria.Effective prevention and treatment measures should be taken to reduce the incidence of HAP for patients with sICH in ICU.
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<p><b>OBJECTIVE</b>To explore evaluation strategies for middle ear dysfunction in cleft palate patients, to optimize the diagnosis and treatment of this dysfunction, and ultimately to improve the comprehensive treatment of cleft palate.</p><p><b>METHODS</b>The relationship among abnormal tympanic types (B, C, and Anomaly), effusion rate, tympanic pressure, and hearing loss were analyzed. We collected relevant information on 469 ears of cleft palate patients and traced one-year longitudinal changes in the tympana of 124 ears from 62 patients with both cleft lip and cleft palate.</p><p><b>RESULTS</b>The effusion rates of cleft palate patients with type B, type C, and type Anomaly were 50.3% (97/193), 34.8% (8/23), and 20.9% (53/253), respectively. The tympanic pressure of the ears with and without effusion showed no significant difference (P>0.05). The hearing loss in type B cleft palate patients with middle ear effusion was worse than that in patients without effusion (P=0.001). However, the hearing loss in type Anomaly showed no difference (P>0.05). The constituent ratio of each tympanic type remained constant during the period between cheiloplasty and palatoplasty for cleft lip and palate patients (P>0.05).</p><p><b>CONCLUSION</b>Cleft palate patients of all tympanic types may all suffer from middle ear effusion at different rates. Examination by centesis is suggested for ears with abnormal tympanic types. Early aggressive therapy is essential for type B cleft palate patients with middle ear effusion to avoid hearing loss. However, catheterization may be not necessary for type Anomaly patients, and conservative observation should be performed instead. Myringotomy with grommet insertion during palatoplasty does not delay treatment timing for patients with both cleft lip and cleft palateg.</p>
Subject(s)
Humans , Cleft Lip , Cleft Palate , Ear, Middle , Physiology , Middle Ear Ventilation , Otitis Media with Effusion , Diagnosis , EpidemiologyABSTRACT
<p><b>OBJECTIVE</b>The glucocorticoid dexamethasone (DEX) can induce palatal cleft; however, the mechanism involved remains unclear. E-cadherin is an important cell adhesion molecule, and it can significantly affect cell fate and embryonic development. Recent studies have indicated that E-cadherin expression in palatal epithelial cells is suppressed in normal palate fusion. This study aimed to determine whether the change in E-cadherin expression is related to the incidence of cleft palate in DEX-induced mice.</p><p><b>METHODS</b>Mice were divided into the experimental group and the control group. Pregnant mice were injected with DEX on E10.0-E12.0, whereas mice in the control group were injected with normal saline. Hematoxylin and eosin (HE) staining, immunohistochemistry, and real-time quantitative polymerase chain reaction were employed to evaluate the effect of DEX on fetal mouse palatal processes, particularly the changes in E-cadherin and β-catenin expression levels in the phases of the experimental and control groups.</p><p><b>RESULTS</b>Data indicated that the incidence of cleft palate in the DEX group was 43.59% (17/39), whereas that in the control group was only 3.03% (1/33). The results of HE staining showed that the obviously shortened palatal processes could not contact and fuse with one another in the DEX-treated mice model compared with those in the control group. The ectopic expression of E-cadherin in embryonic palatal mesenchymal cells was also analyzed. The expression levels of E-cadherin and β-catenin in the experimental group were higher than those in the control group.</p><p><b>CONCLUSION</b>These findings indicated that DEX could induce E-cadherin gene upregulation and ectopic expression, as well as high β-catenin expression, thereby inhibiting the growth of mesenchyme cells and cleft palate.</p>
Subject(s)
Animals , Female , Mice , Pregnancy , Cadherins , Genetics , Metabolism , Cleft Palate , Embryology , Dexamethasone , Disease Models, Animal , Epithelial Cells , Glucocorticoids , Immunohistochemistry , beta Catenin , MetabolismABSTRACT
Objective To provide a practical device and protocol to hold conscious rats for subsequent operations which can overcome the disadvantages of existing methods .Users can complete the experiment more efficiently , with or without prior experience .Methods Using transparent plastic film , plastic sealing machine and sponge to make a simple device for holding rats , by taking advantage of their escaping nature .To compare the performance of the new method and existing methods for holding and injecting rats .Results Compared with existing methods , the new device and method can reduce the time-consuming to hold rats by 44.7%, from 18.13 seconds to 10.03 seconds.For holding and injecting , the new method can reduce the time-consuming by 55.3%, from 139.33 seconds to 52.26 seconds .Conclusions The new device and method is good for holding and injecting rats or drawing blood from the caudal veins .It can shorten the time of operation and reduce the stress reaction in the animals .It’ s especially helpful for inexperienced experimenters such as students in teaching and research tasks .
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<p><b>OBJECTIVE</b>In this study, folic acid (FA) was tested for antiteratogenic effects on Tetrachlorodibenzo-p-dioxin (TCDD)-induced cleft palate in fetal mice.</p><p><b>METHODS</b>In the present study, pregnant mice were dosed with TCDD 24 µg/kg and with or without FA 5 mg/kg body weight on gestation day 10. Control group mice received sesame oil 50 ml/kg body weight on gestation day(GD)10. The mice were sacrificed on GD12.5, GD13.5, GD14.5, GD15.5 and GD16.5. From each pregnant mouse on GD16.5, embryos were obtained to examine under a dissecting microscope, and routine histology was performed for detection and classification of palatal clefts. The fetuses were prepared for histologic examination, scanning electron microscope and TdT-mediated X-dUTP nick and labeling (TUNEL). On GD12.5, GD13.5, GD14.5 and GD15.5. Meanwhile, real-time (RT)-PCR was employed to detect the mRNA expression levels about arylhydrocarbon receptor (AHR) and transforming growth factor (TGF)β3 in this animal model.</p><p><b>RESULTS</b>Total frequencies of clefts were 70.2% in TCDD group(group B) and 66.3% in TCDD+FA group(group C) in relation to control fetuses(group A). Filopodia disappeared completely at the medial edge epithelia surface on GD15.5 (group A), GD12.5 (group B) and GD14.5 (group C). the RT-PCR results showed that TGF -β3 expression was down-regulated on GD13.5 and GD14.5 compared to the control.</p><p><b>CONCLUSIONS</b>It is found that folic acid has no protects agaist 2.3.7.8-TCDD-indued cleft palate in the experiment. Meanwhile, TCDD repressed the TGF-β3 expression during the palatal development. Anormal apoptosis was induced by 2, 3, 7, 8-TCDD at the medial edge epithelia (MEE) during the early development stage.</p>
Subject(s)
Animals , Female , Mice , Pregnancy , Abnormalities, Drug-Induced , Apoptosis , Biomarkers , Cell Polarity , Cleft Palate , Disease Models, Animal , Fetus , Folic Acid , Therapeutic Uses , Mice, Inbred C57BL , Polychlorinated Dibenzodioxins , Toxicity , RNA, Messenger , Receptors, Aryl Hydrocarbon , Genetics , Teratogens , Toxicity , Transforming Growth Factor beta3 , GeneticsABSTRACT
<p><b>OBJECTIVE</b>The purpose of this study was to establish a palatal organ culture method and to investigate the palatogenesis in vitro.</p><p><b>METHODS</b>20 pregnant 14-day mice were killed, embryos were separated ascetically, and palatal shelves were dissected and placed on a modified Trowell's system. All explants were cultured 24 h and 48 h respectively. Finally, all explants were embedded and stained by Hematoxylin and Eosin.</p><p><b>RESULTS</b>All explants grew healthy. After incubation for 24 h, medial edge epithelium maintained, whereas after 48 h, medial edge epithelium disappeared, bilateral mesenchymal cells contacted, palates fused.</p><p><b>CONCLUSION</b>This method provides an effective way for investigating the etiology of cleft palate in vitro.</p>