Continuous circular closure in unilateral cleft lip and plate repair in one surgery.

The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.

Bacterial nanocellulose as a new patch material for closure of ventricular septal defects in a pig model.

OBJECTIVES: Current materials for closure of cardiac defects such as ventricular septal defects (VSDs) are associated with compliance mismatch and a chronic inflammatory response. Bacterial nanocellulose (BNC) is a non-degradable biomaterial with promising properties such as high mechanical strength, favourable elasticity and a negligible inflammatory reaction. The aim of this study was the evaluation of a BNC patch for VSD closure and the investigation of its in vivo biocompatibility in a chronic pig model. METHODS: Young's modulus and tensile strength of BNC patches were determined before and after blood exposure. Muscular VSDs were created and closed with a BNC patch on the beating heart in an in vivo pig model. Hearts were explanted after 7, 30 or 90 days. Macropathology, histology and immunohistochemistry were performed. RESULTS: Young's modulus and tensile strength of the BNC patch decreased after blood contact from 6.3 ± 1.9 to 3.86 ± 2.2 MPa (P < 0.01) and 0.33 ± 0.06 to 0.26 ± 0.06 MPa (P < 0.01), respectively, indicating the development of higher elasticity. Muscular VSDs were closed with a BNC patch without residual shunting. After 90 days, a mild chronic inflammatory reaction was present. Moreover, there was reduced tissue overgrowth in comparison with polyester. Proceeding cellular organization characterized by fibromuscular cells, production of extracellular matrix, neoangiogenesis and complete neoendothelialization were found. There were no signs of thrombogenicity. CONCLUSIONS: BNC patches can close VSDs with good mid-term results and its biocompatibility can be considered as satisfactory. Its elasticity increases in the presence of blood, which might be advantageous. Therefore, it has potential to be used as an alternative patch material in congenital heart disease.

Intraoperative vascular anatomy, arterial blood flow velocity, and microcirculation in unilateral and bilateral cleft lip repair.

BACKGROUND: Cleft lip repair aims to normalize the disturbed anatomy and function. The authors determined whether normalization of blood circulation is achieved. METHODS: The authors measured the microcirculatory flow, oxygen saturation, and hemoglobin level in the lip and nose of controls (n = 22) and in patients with unilateral and bilateral cleft lip-cleft palate. The authors measured these parameters before lip repair (n = 29 and n = 11, respectively), at the end of lip repair (n = 27 and 10, respectively), and in the late postoperative period (n = 33 and n = 20, respectively). The arterial flow velocity was measured in unilateral groups at the same time points (n = 13, n = 11, and n = 12, respectively). Statistical differences were determined using analysis of variance. RESULTS: Before surgery, the arterial flow velocities and microcirculation values were similar on each side of the face and between groups. The microcirculatory flow was significantly higher in the prolabium of bilateral patients than in the philtrum of controls. All circulation values in unilateral and bilateral patients in the late postoperative period were within the range of controls and of those before surgery. Intraoperatively, the authors consistently found a perforating artery on the superficial side of the transverse nasalis muscle. CONCLUSIONS: There appears to be no intrinsic circulatory deficit in unilateral and bilateral cleft lip-cleft palate patients. The increased flow in the prolabium indicates a strong hemodynamic need in this territory, compelling its vascular preservation. Whether surgical preservation of the nasalis perforator artery is of long-term benefit should be addressed in future studies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

[Diagnostic value of nasometry--representative study of patients with cleft palate and normal subjects]. / Die diagnostische Wertigkeit der Nasometrie--eine reprasentative Studie fur Patienten mit Lippen-Kiefer-Gaumensegel-Spalten und Gesunde.

In the rehabilitation of cleft palate patients the quality of spoken language represents one of the most important aspects of successful social integration. It is therefore necessary to direct special attention to phoniatric care and speech therapy following operative reconstruction. One of the main problems is the comparison of subjective and objective measures of the degree and type of nasal disorder. In an interdisciplinary project at the University of Jena nasometry was assessed. Due to a lack of norm values for German a representative sample for the calibration of cleft palate patients and normal subjects was collected. Speech was elicited using standardized and phonetically validated reading materials. Nasalance measurements were compared with judgements made by a group of trained listeners who were asked to assess voice quality (RBH) and nasality. A database containing nasalance values and acoustic signals from 120 subjects was built up. The results generally exhibited highly significant correlations between instrumental measurements and auditory judgements. Profiles of norm values for a phonetically and statistically reliable standard for German were obtained, which in turn can be used as a comparative basis for further studies.

Treatment options in distraction osteogenesis therapy using a new bidirectional distractor system.

PURPOSE: The purpose of this retrospective study was to compare a bidirectional distraction system with a unidirectional system with regard to bone height attained and the need for secondary graft procedures. MATERIALS AND METHODS: Unidirectional and bidirectional distractor devices were used for vertical augmentation of the maxilla and mandible in 2 separate groups of patients (n = 10 and n = 11, respectively). Clinical and radiographic outcome data were collected at postoperative follow-up examinations for up to 2.5 years. The height of the augmented alveolar ridge and the sagittal location of the bone fragment were measured on panoramic radiographs or lateral cephalograms. These data were analyzed with 1-way analysis of variance. Nonparametric data, such as treatment complications, were analyzed with the Fisher exact test. The dental implant survival data were evaluated with a Kaplan-Meier survival analysis. RESULTS: The difference in vertical bone gain observed between unidirectional and bidirectional groups (5.3 +/- 1.8 mm vs 6.1 +/- 2.3 mm) was not statistically significant. In the unidirectional group, additional autogenous bone grafting was required in 6 cases, while grafting was required in only 2 cases in the bidirectional group. This difference was due to the more precise control of the distraction process associated with the bidirectional distractor; however, it was not a statistically significant difference. Postaugmentation, 59 implants were placed in the augmented sites. These implants exhibited primary stability and were restored with good functional and esthetic results. CONCLUSIONS: The need for additional grafting procedures may be reduced in cases where the distraction vector is optimized, as generally seen with bidirectional distractor use.

Photodynamic therapy of virus-associated epithelial tumours of the face in organ transplant recipients.

PURPOSE: The benefit for organ recipients is still counteracted by the side effects of immunosuppression. Among other effects, there is a 50-250 times increased risk of developing malignant skin tumours. Because these malignomas are known to develop particularly aggressivly, there is a special need for an efficient therapy. Here we demonstrate the treatment response to aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) in these patients. METHODS: Five organ recipients with multiple tumours of the face were multifocally treated with ALA-PDT (32 tumours in all). After topical application of ALA using a thermogel, irradiation was done with a 635 nm diode laser (Ceralas 635, Biolitec, Jena, Germany). After intervals of 2 weeks, 4 weeks, and 12 weeks, therapeutic efficacy was assessed. RESULTS: There was complete remission in 24 tumours (75%). In six tumours (18.8%) a second or third PDT session was necessary for complete clinical remission. In two tumours (5.6%, invasive squamous cell carcinomas) the lesions were refractory to PDT. CONCLUSIONS: ALA-PDT is a valuable therapeutic alternative for the treatment of multifocal skin tumours in organ-transplanted patients. Furthermore, we see a growing role of ALA-PDT also for patients with frequently relapsing tumours of the skin with known genetically determined tumourigenesis (Gorlin-Goltz syndrome).