Two-point nasomaxillary fixation of the Le Fort I osteotomy: assessment of stability at one year postoperative.

The purpose was to assess maxillary position among patients undergoing Le Fort I maxillary advancement with internal fixation placed only at the nasomaxillary buttresses. This was a retrospective study of patients undergoing a Le Fort I osteotomy for maxillary advancement, with internal fixation placed only at the nasomaxillary buttresses. Demographic and cephalometric measures were recorded. The outcome of interest was the change in maxillary position between immediately postoperative (T1), 6 weeks postoperative (T2), and 1 year postoperative (T3). Fifty-eight patients were included as study subjects (32 male, 26 female; mean age 18.4±1.8 years). Twenty-five subjects (43.1%) had a diagnosis of cleft lip and palate. Forty-three subjects (74.1%) had bimaxillary surgery, 16 (27.6%) had bone grafts, and 18 (31.0%) had segmental maxillary osteotomies. At T3, there were no subjects with non-union, malunion, malocclusion, or relapse requiring repeat surgery. Mean linear changes between T1 and T3 were ≤1mm. Mean angular changes between T1 and T3 were <1°. There was no significant difference in stability in multi-segment maxillary osteotomies (P= 0.22) or with bone grafting (P= 0.31). In conclusion, anterior fixation alone in the Le Fort I osteotomy results in a stable maxillary position at 1 year postoperative.

Is alteration of the occlusal plane stable with isolated nasomaxillary fixation of the Le Fort I osteotomy?

The purpose of this work was to evaluate the stability of maxillary position in the setting of occlusal plane rotations in bimaxillary surgery with rigid fixation of the mandible and bilateral nasomaxillary fixation at the Le Fort I level. This was a retrospective assessment of patients undergoing bimaxillary surgery for the correction of dentofacial deformities with occlusal plane alterations. Demographic measures assessed included age, sex, history of craniofacial anomaly, segmental maxillary osteotomy, and maxillary bone grafting. Cephalometric measures assessed included occlusal plane rotation (clockwise (CWR) or counterclockwise (CCWR)), angular measurements of maxillary and mandibular position (SNA, SNB, and ANB), and occlusal plane angle (occlusal plane to corrected Frankfort horizontal); these were assessed preoperatively (T0) and immediately (T1), 6 weeks (T2), and 1year postoperative (T3). Descriptive and bivariate statistics were computed; P≤0.05 was considered significant. Thirty-six patients were included as study subjects (mean age 18.6±1.8 years; 17 (47.2%) female); 27 (75%) had a primary diagnosis of craniofacial anomaly. Eleven patients (30.6%) had segmental maxillary osteotomies; 10 patients (27.8%) had simultaneous maxillary bone grafting. Twelve patients underwent CCWR; 24 patients underwent CWR. No patient required repeat surgery for malocclusion or relapse; there were no malunions or non-unions during follow-up. For CCWR patients, the mean occlusal plane change from preoperative to postoperative was 5.8±2.8°, remaining stable at 1 year postoperative (ΔT3-T1 1.6±1.0°, P>0.05). For CWR patients, the mean occlusal plane rotation was 4.5 ± 2.2°, remaining stable at 1 year postoperative (ΔT3-T1 1.1±0.9°, P>0.05). In patients undergoing bimaxillary surgery for occlusal plane rotation, two-point fixation of the Le Fort I osteotomy resulted in a stable maxillary position at 1 year postoperative.

Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper.

OBJECTIVES: A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery. SETTING AND SAMPLE POPULATION: The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion. MATERIAL AND METHODS: A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study. RESULTS: Current recruitment of patients is on track to complete the study within the proposed recruitment period. CONCLUSION: This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.

Genes affecting tooth morphogenesis.

The development of dentition is a fascinating process that encompasses a complex series of epithelial-mesenchymal interactions involving growth factors, transcription factors, signal receptors and other soluble morphogens. It is not surprising that such a complex process is prone to disturbances and may result in tooth agenesis. Initial discoveries indicating that the homeo-domain protein MSX1 and the paired-domain transcription factor PAX9 are causative genes in tooth morphogenesis were made in mice. Both genes are co-expressed in dental mesenchyme and either one, when homozygously deleted, results in an arrest at an early developmental stage. Previous studies have shown a down regulation of Bmp4 gene expression in Pax9 and Msx1 single mutant mice. Therefore, we chose to explore the molecular relationship between Pax9, Msx1 and Bmp4. In humans, unlike in mice, a heterozygous mutation in either PAX9 or MSX1 suffices to cause tooth agenesis of a predominantly molar or more premolar pattern, respectively. Our laboratory and others have identified several PAX9 and MSX1 mutations in families with non-syndromic forms of autosomal dominant posterior tooth agenesis. We have also identified families with tooth agenesis in whom PAX9 and MSX1 mutations have been excluded opening up the possibilities for the discovery of other genes that contribute to human tooth agenesis.

Genes affecting tooth morphogenesis.

The development of dentition is a fascinating process that encompasses a complex series of epithelial-mesenchymal interactions involving growth factors, transcription factors, signal receptors and other soluble morphogens. It is not surprising that such a complex process is prone to disturbances and may result in tooth agenesis. Initial discoveries indicating that the homeo-domain protein MSX1 and the paired-domain transcription factor PAX9 are causative genes in tooth morphogenesis were made in mice. Both genes are co-expressed in dental mesenchyme and either one, when homozygously deleted, results in an arrest at an early developmental stage. Heterozygous Pax9 or Msx1 mice have normal teeth, however, double heterozygous Pax9/Msx1 mice show a phenotype of arrested tooth development which can be rescued by transgenic expression of Bmp4, a very influential signaling factor in many developmental processes. We have obtained mounting evidence for a partnership between PAX9 and MSX1 within the tooth-specific Bmp4 signaling pathway. In humans, unlike in mice, a heterozygous mutation in either PAX9 or MSX1 suffices to cause tooth agenesis of a predominantly molar or more premolar pattern, respectively. Our laboratory and others have identified several PAX9 and MSX1 mutations in families with non-syndromic forms of autosomal dominant posterior tooth agenesis. We have also identified families with tooth agenesis in whom PAX9 and MSX1 mutations have been excluded opening up the possibilities for the discovery of other genes that contribute to human tooth agenesis.

The life and work of the Birmingham radiologist Dr James Brailsford (1888-1961).

James Brailsford went from humble beginnings to become an eminent radiologist through his ability, determination and immense diligence. He made a late start in medicine but became one of the world's leading authorities on skeletal diseases; he wrote the classic textbook The Radiology of Bones and Joints and described the eponymous Morquio-Brailsford syndrome. In 1934 he was elected first President of the British Association of Radiologists, of which he was founder. This later became the Faculty of Radiologists at the Royal College of Surgeons and is now the Royal College of Radiologists.

Antenatal renal pelvis dilatation emphasizing vesicoureteric reflux: two-year follow-up of minor postnatal dilatation.

AIM: To describe the occurrence of foetal renal pelvis dilatation in an unselected population of pregnancies and to describe the clinical course in a subgroup of infants with minor renal pelvis dilatation (RPD). METHODS: During 1996-1999 the foetuses of 17850 consecutive pregnant women were scanned with ultrasonography (USG) in the 16th-19th gestational week and later in the pregnancy when indicated. RPD was defined as anterior-posterior pelvic diameter > or = 5 mm. After birth all infants were examined with USG twice. If any postnatal USG showed RPD > or = 10 mm, extended radiological investigation was performed. Infants with pelvis dilatation < 10 mm and no calyceal or ureteric dilatation were not investigated further and antibiotic prophylaxis was discontinued. The children were followed up at 2 y of age. RESULTS: 109 foetuses (0.6%) with RPD were identified. Postnatally, 94/109 were available for follow-up: 43 had postnatal dilatation > or = 10 mm and were investigated and treated according to clinical routine, while 51 had dilatation < 10 mm and were followed up after they had reached at least 2 y of age. No case of pyelonephritis was recorded. USG in 48/51 children was normal. CONCLUSION: The data indicate that infants with minor RPD do not constitute a risk group for renal morbidity and thus do not need antibiotic prophylaxis and extensive radiological examination.

Perinatal water intoxication due to excessive oral intake during labour.

UNLABELLED: The increased body water in pregnant women and the birth-related activation of water-sparing systems contribute to a high risk of perinatal water intoxication if the mother drinks too much water during labour. This study reports on four newborn term infants and one mother presenting with life-threatening symptoms due to hyponatraemia from excessive oral intake during labour. Awareness of this diagnosis in the delivery unit is very important, because the clinical picture may mimic that of pre-eclampsia or dehydration. CONCLUSION: Guidelines are proposed to prevent and treat perinatal water intoxication due to excessive oral intake during labour.

Amyloid goiter--a case report.

Microscopic infiltration of the thyroid gland by amyloid is an uncommon but well recognized phenomenon and significant enlargement of the thyroid due to deposition of amyloid is rarely seen. This condition has to be distinguished from other types of goiters and at times from malignancy. In spite of extensive involvement of the gland by amyloid, thyroid function usually remains normal. Here, we describe a rare case of amyloid goiter without amyloid deposits in any other organs of the body. The case presented in an unusual clinical settings of relatively rapid enlargement of thyroid with pressure symptoms and was unassociated with any immuno-proliferative or chronic diseases.

Evaluation of a curriculum for dental health in 3rd grade school children in Mumbai, India.

Utilising the Bright Smiles, Bright Future curriculum as modified for India, a trial on its effectiveness was carried out at the Raja Shivaji School in Mumbai, India. Students from the third standard English medium were selected. The teacher training programme utilised a professional educator from the U.S.A. plus other international representatives including India. Prior to the beginning of any classroom instruction, all experimental and control students were scored for plaque. A pretest was also given to both the experimental and control students to measure their knowledge of dental health. At the end of the two month test period all measurements were repeated. The curriculum was evaluated by the teachers. Parents were also interviewed. Results showed significant (P < .0001) difference between the two groups in reducing plaque, which demonstrated the improvement in oral hygiene in the experimental group.

Complement-induced expression of chemokine genes in endothelium: regulation by IL-1-dependent and -independent mechanisms.

Activation of complement in the vicinity of endothelium is thought to contribute to the tissue manifestations of inflammatory and immune responses. Endothelial cells contribute to these processes in part by the elaboration of chemokines that activate various leukocytes and direct their migration into tissues. We investigated the mechanisms by which activation of complement on endothelial cell surfaces might influence the expression of chemokine genes in endothelial cells. In a model for the immune reaction occurring in a xenograft, human serum, as a source of xenoreactive anti-endothelial Abs and complement, induced expression of the monocyte chemotactic protein-1 (MCP-1), IL-8, and RANTES genes. The MCP-1 and IL-8 genes were expressed within 3 h as a first phase and at > 12 h as a second phase. The RANTES gene was expressed in porcine endothelial cells only 12 h after exposure to human serum. The expression of these genes required activation of complement and assembly of membrane attack complex, as it was inhibited by soluble CR1 and did not occur in the absence of C8. The early phase of MCP-1 and IL-8 gene expression did not require de novo protein synthesis. The late phase of MCP-1, IL-8, and RANTES gene expression predominantly required the production of IL-1alpha as an intermediate step. The results indicate that the expression of chemokine genes in endothelial cells occurs as a function of differential responses to complement and may in part be conditioned by the availability of IL-1alpha.

Some properties of monkey intestinal sucrase.

A detergent solubilised sucrase from monkey small intestine has been purified 388-fold to gel electrophoretic homogeneity with an overall recovery of 36%. The molecular weight of the enzyme was 263 kDa by gel filtration. Electrophoresis in the presence of SDS indicates that the enzyme is a hetero-dimer. Mixed substrate inhibition studies and inhibition by PCMB and Tris suggest the presence of two catalytically active sites in the form of maltase and sucrase with isomaltase activity being common to both sites. Polyclonal antiserum against the purified enzyme showed a single continuous precipitin line with the purified antigen.