Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review.

INTRODUCTION: Cleft lip with or without cleft palate (CL/P) stands as the most common congenital facial anomaly, stemming from multifactorial causes. OBJECTIVE: Our study aimed to ascertain the prevalence and characteristics of cleft palates, identify associated risk factors to inform prevention and prenatal detection for early intervention, and assess postoperative rehabilitation protocols for cleft palates. DESIGN: This study employs a retrospective descriptive and clinical approach. PATIENTS: The study includes 103 children with cleft palates treated at the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury. METHODS: We conducted a thorough evaluation of records, considering variables such as sex, cleft type, maternal occupation, parental education, and family history of clefts. Data analysis was carried out using R software version GPL-3 and ordinal logistic regression analyses. RESULTS: Notably, children born to mothers who experienced significant stress during pregnancy exhibited a 9.4-fold increase in the odds of having bilateral cleft palates. Conversely, no substantial evidence was found to support the influence of the child's sex, birth order, body mass, maternal exposure to workplace toxins, infections, or drug toxicity on the dependent variable. CONCLUSIONS: Our findings suggest that children with parents who have a history of clefts and those with less educated mothers are more likely to develop bilateral cleft palates. Additionally, children born to mothers experiencing stress during pregnancy face an increased risk of bilateral cleft palates. It is important to note that there is a paucity of literature on rehabilitation following various cleft palate surgical techniques in children.

Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review.

BACKGROUND: Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature. METHODS: PEDro, Medline (PubMed), Cochrane Clinical Trials were searched. RESULTS: 767 articles were found. 40 articles were included to this literature review. CONCLUSIONS: Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.

Biomechanical Evaluation of Temporomandibular Joint Reconstruction Using Individual TMJ Prosthesis Combined with a Fibular Free Flap in a Pediatric Patient.

The main aim of this study was to perform a complex biomechanical analysis for a custom-designed temporomandibular joint (TMJ) prosthesis in combination with a fibular free flap in a pediatric case. Numerical simulations in seven variants of loads were carried out on 3D models obtained based on CT images of a 15-year-old patient in whom it was necessary to reconstruct the temporal-mandibular joints with the use of a fibula autograft. The implant model was designed based on the patient's geometry. Experimental tests on a manufactured personalized implant were carried out on the MTS Insight testing machine. Two methods of fixing the implant to the bone were analyzed-using three or five bone screws. The greatest stress was located on the top of the head of the prosthesis. The stress on the prosthesis with the five-screw configuration was lower than in the prosthesis with the three-screw configuration. The peak load analysis shows that the samples with the five-screw configuration have a lower deviation (10.88, 0.97, and 32.80%) than the groups with the three-screw configuration (57.89 and 41.10%). However, in the group with the five-screw configuration, the fixation stiffness was relatively lower (a higher value of peak load by displacement of 171.78 and 86.46 N/mm) than in the group with the three-screw configuration (where the peak load by displacement was 52.93, 60.06, and 78.92 N/mm). Based on the experimental and numerical studies performed, it could be stated that the screw configuration is crucial for biomechanical analysis. The results obtained may be an indication for surgeons, especially during planning personalized reconstruction procedures.

Children with Rare Nager Syndrome-Literature Review, Clinical and Physiotherapeutic Management.

Nager syndrome is a rare human developmental disorder characterized by craniofacial defects including the downward slanting of the palpebral fissures, cleft palate, limb deformities, mandibular hypoplasia, hypoplasia or absence of thumbs, microretrognathia, and ankylosis of the temporomandibular joint. The prevalence is very rare and the literature describes only about a hundred cases of Nager syndrome. There is evidence of autosomal dominant and autosomal recessive inheritance for Nager syndrome, suggesting genetic heterogeneity. The majority of the described causes of Nager syndrome include pathogenic variants in the SF3B4 gene, which encodes a component of the spliceosome; therefore, the syndrome belongs to the spliceosomopathy group of diseases. The diagnosis is made on the basis of physical and radiological examination and detection of mutations in the SF3B4 gene. Due to the diversity of defects associated with Nager syndrome, patients require multidisciplinary, complex, and long-lasting treatment. Usually, it starts from birth until the age of twenty years. The surgical procedures vary over a patient's lifetime and are related to the needed function. First, breathing and feeding must be facilitated; then, oral and facial clefts should be addressed, followed by correcting eyelid deformities and cheekbone reconstruction. In later age, a surgery of the nose and external ear is performed. Speech and hearing disorders require specialized logopedic treatment. A defect of the thumb is treated by transplanting a tendon and muscle or transferring the position of the index finger. In addition to surgery, in order to maximize a patient's benefit and to reduce functional insufficiency, complementary treatments such as rehabilitation and physiotherapy are recommended. In our study, we describe eight patients of different ages with various cases of Nager syndrome. The aim of our work was to present the actual genetic knowledge on this disease and its treatment procedures.

Analysis of the effects of mandibular reconstruction based on microvascular free flaps after oncological resections in 21 patients, using 3D planning, surgical templates and individual implants.

INTRODUCTION: Post- resection defects in the area of the head and neck frequently result in functional impairment of the masticatory system and unaesthetic outcome in the facial appearance. In pediatric population they exert a devastating effect on speech development, breathing and facial growth leading to secondary deformations which are extremely challenging in reconstruction by means of conventional surgery protocols. MATERIAL AND METHODS: 21 patients (14 males/ 7 females) aged 4-17 years old, treated between 2015 and 2019 due to malignant/benign tumors or congenital deformities requiring mandible resection were enrolled in the study. All patients underwent Virtual Surgical Planning (VSP), mandible tumor resection with use surgery guides and defect reconstruction with microvascular bone graft supported with custom implants. Postoperatively, 3D models used for the planning and postoperative 3D model of the reconstructed mandible were compared using authors method based on easily measurable morphometric measurements (3 angles, 3 linear dimensions), allowing a three-dimensional quantitative assessment of postoperative outcomes of the surgery. Linear regression analysis and one-way analysis of variance were used to evaluate the clinical material. The difference was considered significant if p < 0.05. RESULTS: Free fibula flap (FFF) was most commonly used type of the reconstruction of the pediatric mandible. The average maximum deviation for the analyzed cases was 7.7 mm, and the average minimum deviation was -6.09 mm, however without significant differences and the postoperative position of the mandible condyle was comparable to the position designed in the 3DVSP preoperatively. Position of the whole reconstructed mandible by means of individually planned grafts and plates provided comparable position of the ramus and mandible body and no chin deviation as the differences between the pre-operative axial and sagittal angles and their post-operative equivalents were insignificant (p > 0,05). CONCLUSIONS: This study confirms applicability of the 3DVSP in pediatric craniomaxillofacial surgery. Preoperative planning of the osteotomies, grafting technique and production of the individualized guides and implants provides precise tumor resection and immediate reconstruction adjusted to the specific anatomy of the pediatric patients.

Efficacy of immediate physiotherapy after surgical release of zygomatico-coronoid ankylosis in a young child: A case report.

BACKGROUND: Temporomandibular joint ankylosis (TMJ ankylosis) manifests itself as a locked jaw and reduced mouth opening. We hypothesized that the efficacy of TMJ ankylosis surgery in a child may largely depend on physiotherapeutic management. CASE DESCRIPTION: In this case report, we present the treatment of a girl between 1 and 4 years of age, who was unable to open her jaws immediately after birth. Congenital ankylosis was diagnosed. INTERVENTION: Two models of therapeutic management were presented, with a surgical procedure to release bone fusion adopted as a starting point. In the first model, the rehabilitation procedure started 21 days after surgery. OUTCOMES: Despite rehabilitation, no clinical improvement was achieved (i.e. the child was still unable to open her jaws). In the second model, rehabilitation started from the day after surgery and management according to the second model allowed for obtaining therapeutic benefits. After therapy, the girl was able to abduct the mandible to a degree allowing for improved speech and the ability to crush food. CONCLUSIONS: This clinical case shows that the efficacy of surgical procedures may depend on the type of postoperative management. It was demonstrated that physiotherapy started immediately after the procedure to release the ankylosis improved the mandible mobility outcomes for this child.

Lower Leg Injury Mechanism Investigation During an IED Blast Under a Vehicle Using an Anatomic Leg Model.

Attacks with improvised explosive device (IED) constituted the main threat to, for example, Polish soldiers in Iraq and Afghanistan. Improving safety during transport in an armored vehicle has become an important issue. The main purpose of the presented research is to investigate the mechanism of lower leg injuries during explosion under an armored vehicle. Using a numerical anatomic model of the lower leg, the analysis of the leg position was carried out. In all presented positions, the stress limit of 160 (MPa) was reached, which indicates bone damage. There is a difference in stress distribution in anatomic elements pointing to different injury mechanisms.

Assessment of the Impact of Decellularization Methods on Mechanical Properties of Biocomposites Used as Skin Substitute.

This work aimed to assess the impact of acellularization and sterilization methods on the mechanical properties of biocomposites used as a skin substitute. On the basis of the statistical analysis, it was ascertained that the values of the Young modulus for the samples before the sterilization process-only in the cases of substances such as: trypsin, 15% glycerol and dispase-changed in a statistically significant way. In the case of dispase, the Young modulus value before the sterilization process amounted to 66.6 MPa, for trypsin this value equalled 33.9 MPa, whereas for 15% glycerol it was 11 MPa. In the case of samples after the completion of the sterilization process, the analysis did not show any statistically significant differences between the obtained results of Young's modulus depending on the respective reagents applied. It was confirmed that different methods of acellularization and the process of sterilization effect the alteration of mechanical properties of allogeneic skins. In the case of the decellularization method using SDS (Sodium Dodecyl Sulfate), liquid nitrogen and 85% glycerol the highest values of strain were observed. In the authors' opinion, it is the above-mentioned methods that should be recommended in the process of preparation of skin substitutes.

Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients.

BACKGROUND: Previously published computational fluid dynamics (CFD) studies regarding intracranial aneurysm (IA) formation present conflicting results. Our study analysed the involvement of the combination of high wall shear stress (WSS) and a positive WSS gradient (WSSG) in IA formation. METHODS: We designed a case-control study with a selection of 38 patients with an unruptured middle cerebral artery (MCA) aneurysm and 39 non-aneurysmal controls to determine the involvement of WSS, oscillatory shear index (OSI), the WSSG and its absolute value (absWSSG) in aneurysm formation based on patient-specific CFD simulations using velocity profiles obtained from transcranial colour-coded sonography. RESULTS: Among the analysed parameters, only the WSSG had significantly higher values compared to the controls (11.05 vs - 14.76 [Pa/mm], P = 0.020). The WSS, absWSSG and OSI values were not significantly different between the analysed groups. Logistic regression analysis identified WSS and WSSG as significant co-predictors for MCA aneurysm formation, but only the WSSG turned out to be a significant independent prognosticator (OR: 1.009; 95% CI: 1.001-1.017; P = 0.025). Significantly more patients (23/38) in the case group had haemodynamic regions of high WSS combined with a positive WSSG near the bifurcation apex, while in the control group, high WSS was usually accompanied by a negative WSSG (14/39). From the analysis of the ROC curve for WSSG, the area under the curve (AUC) was 0.654, with the optimal cut-off value -0.37 Pa/mm. The largest AUC was recognised for combined WSS and WSSG (AUC = 0.671). Our data confirmed that aneurysms tend to form near the bifurcation apices in regions of high WSS values accompanied by positive WSSG. CONCLUSIONS: The development of IAs is determined by an independent effect of haemodynamic factors. High WSS impacts MCA aneurysm formation, while a positive WSSG mainly promotes this process.

Mechanical, Chemical, and Processing Properties of Specimens Manufactured from Poly-Ether-Ether-Ketone (PEEK) Using 3D Printing.

As part of the experiments herein, the mechanical properties of specimens made of poly-ether-ether-ketone (PEEK) material using 3D printing technology were determined. Two populations of specimens were investigated, the first of which contained an amorphous structure, while the other held a crystal structure. The studies also investigated the influence of the print directionality on the mechanical properties obtained. Static tensile, three-point bending, and impact tests were carried out. The results for the effect of the structure type on the tensile properties showed that the modulus of elasticity was approximately 20% higher for the crystal than for the amorphous PEEK form. The Poisson's ratios were similar, but the ratio was slightly higher for the amorphous samples than the crystalline ones. Furthermore, the studies included a chemical PEEK modification to increase the hydrophilicity. For this purpose, nitrite and hydroxyl groups were introduced into the chain by chemical reactions. The results demonstrate that the modified PEEK specimens had worse thermoplastic properties than the unmodified specimens.

Finite element head model for the crew injury assessment in a light armoured vehicle.

PURPOSE: The aim of this paper was the development of a finite element model of the soldier's head to assess injuries suffered by soldiers during blast under a light armoured vehicle. METHODS: The application of a multibody wheeled armoured vehicle model, including the crew and their equipment, aenabled the researchers to analyse the most dangerous scenarios of the head injury. These scenarios have been selected for a detailed analysis using the finite element head model which allowed for the examination of dynamic effects on individual head structures. In this paper, the authors described stages of the development of the anatomical finite element head model. RESULTS: The results of the simulations made it possible to assess parameters determining the head injury of the soldier during the IED explosion. The developed model allows the determination of the parameters of stress, strain and pressure acting on the structures of the human head. CONCLUSION: In future studies, the model will be used to carry out simulations which will improve the construction of the headgear in order to minimize the possibility of the head injury.

Wear Morphology on the Surfaces of CoCrMo Unicompartmental Knee Joint Endoprostheses as Elements of Metal-Metal Friction Nodes.

The article assesses the strength and structural parameters of load-bearing layers of metal biobearings made of CoCrMo alloy. The research material consisted of unicompartmental knee joint endoprostheses used in the human body, removed due to excessive wear. No patient participated in the examinations. The endoprostheses used as research material underwent the liquidation procedures in the hospital, which has all necessary permissions and certifications to perform endoprosthetic procedures. Endoprostheses selected for the examinations had been used for 6 to 12 years at similar load conditions as declared by the patients, i.e., body weight of F = 835 N, declared activity expressed as the number of load cycles up to 100 thousand/year, and no artificial joint infections. To assess the homogeneity of the research material, the analysis of chemical composition using a Joel scanning electron microscope with EDS (Energy-dispersive X-ray spectroscopy) was made to exclude endoprostheses with various alloying additives. Microscopic examinations were performed using the Phenom XL microscope, while the wear surface was examined using a Keyence VHX-900F microscope. Several experimental tests were also carried out on load-bearing surfaces to assess changes in strength parameters of the base material after a known life cycle and load conditions. Material hardness using the Vickers method, yield point, critical value of stress intensity coefficient, and the coefficient of friction µ were evaluated. The examinations allowed for the systematization of wear in the knee and femoral components of unicompartmental hip endoprostheses. The statistical evaluation of the number and costs of hip joint replacement surgeries in Poland was also made.

Morphological and Hemodynamic Risk Factors for Middle Cerebral Artery Aneurysm: a Case-Control Study of 190 Patients.

This study analyzed morphometric and hemodynamic parameters of aneurysmal and non-aneurysmal middle cerebral artery (MCA) bifurcations and their relationship with optimal values derived from the principle of minimum work (PMW). The study included 96 patients with MCA aneurysm and 94 controls. Aneurysm patients presented with significantly higher values of the radius and cross-sectional area of the MCA trunk, angle between the post-bifurcation branches (α angle) and volume flow rate (VFR) and had significantly lower values of junction exponent and pulsatility index than the controls. The Φ1 and Φ2 angles (angles between the MCA trunk axis and the larger and smaller branch, respectively) and α angle in all groups were significantly larger than the optimal PMW-derived angles. The most important independent predictors of MCA aneurysm were junction exponent (odds ratio, OR = 0.42), α angle (OR = 1.07) and VFR (OR = 2.36). Development of cerebral aneurysms might be an independent effect of abnormalities in hemodynamic and morphometric factors. The risk of aneurysm increased proportionally to the deviation of morphometric parameters of the bifurcation from their optimal PMW-derived values. The role of bifurcation angle in aneurysm development needs to be explained in future research as the values of this parameter in both aneurysm patients and non-aneurysmal controls in were scattered considerably around the PMW-derived optimum.

Numerical and experimental analysis of balloon angioplasty impact on flow hemodynamics improvement.

PURPOSE: The paper focuses on the numerical and experimental evaluation of the fluid flow inside chosen fragments of blood vessels. In the first stage of the study, the experimental tests were conducted using a research test stand, designed to be used in this evaluation. The study evaluated the blood flow through a silicone vessel with an implanted coronary stent. METHODS: The PIV method was used in order to visualize the flow vectors inside a silicone vessel. Deformed vessel geometry implemented for computational fluid dynamics purposes was obtained owing to a non-linear simulation of the stent expansion (angioplasty process) in a silicone vessel. Additionally, a vessel model with a statistical 55% area stenosis and an irregular real vessel with an atherosclerotic plaque were also subjected to analysis from the hemodynamic flow point of view. A vessel with a statistical stenosis was also used to simulate the angioplasty process, which resulted in obtaining a flow domain for the vessel with an atherosclerotic plaque after the stent implantation. RESULTS: For each case, distributions of parameters such as OSI or TAWSS were also analyzed and discussed. The areas of low TAWSS values appear close to the stent struts. CONCLUSIONS: Stents with increased diameters, compared to the normal vessel diameter, create a higher risk of occurrence of the areas with low WSS values. Excessive stent deformation can cause inflammation by injuring the vessel and can initiate the restenosis and thrombotic phenomena through the increased vessel diameter.

Evaluation of the impact of decellularization and sterilization on tensile strength transgenic porcinedermal dressings.

PURPOSE: The aim of this paper was to evaluate which method of acellularization and sterilization is optimal, in the meaning of which processes have the least impact on the deterioration of mechanical properties of porcine tissues used for xenogeneic applications. METHODS: The static tensile probe was conducted for 80 skin specimens obtained from transgenic swine, which are used as a wound dressing for skin recipient. Obtained data were subsequently analyzed with the use of statistical methods. RESULTS: It was found that Young's modulus for the samples after the sterilization process for the dispase substance and the mixed method (SDS + trypsin) were statistically significantly changed. In the case of dispase, Young's modulus value before the sterilization process was 12.4 MPa and after the value increased to 28.0 MPa. For the mixed method (SDS + trypsin) before the sterilization process Young's modulus value was 5.6 MPa and after it was increased to 6.3 MPa. The mixed method (SDS + trypsin) had the slightest effect on changing the mechanical properties of the samples before and after the sterilization process. CONCLUSIONS: It was confirmed that different methods of acellularization and the process of sterilization have an influence on the change of mechanical properties of the skin of transgenic swine. In the authors' opinion, the mixed method (SDS + trypsin) should be recommended as the best one for the preparation of transgenic porcine dermal dressings because it ensures a smaller probability of dressing's damage during a surgical procedure.

Decreased Bone Mineral Density in Forearm vs Loaded Skeletal Sites in Professional Ballet Dancers.

AIMS: To compare the differences in bone mineral density (BMD) at loaded and non-loaded skeletal sites in professional ballet dancers. We hypothesized that in both male and female elite ballet dancers, a significant difference in BMD will be observed between impact and non-impact sites. METHODS: 44 elite ballet dancers, 22 men (age 26.4±5.9 yrs) and 22 women (age 24.9±5.3 yrs), were examined. BMD measurements were performed using dual-energy x-ray absorptiometry at three skeletal sites-forearm (FA), lumbar spine (LS), and femoral neck (FN)-and analyzed using t-tests, ANOVA, and linear regression models. Information about career duration, training volume, health habits, and menstrual disorders (women) was collected. RESULTS: Z-scores for LS and FN were significantly higher in men than in women. However, Z-scores for FA were similar in men and women and fell below the expected range for age (<-2.0), and they were significantly lower than those for LS and FN. With longer career duration, a trend was observed towards lower Z-scores for FN in men and towards higher Z-scores for FA in women. CONCLUSION: In ballet dancers, FA mineralization is extremely low compared to loaded skeletal sites. Male dancers may have lowered forearm BMD despite the absence of risk factors present in female dancers (menstrual disorders). Professional ballet dancers may be at risk of local osteopenia due to the "local non-impact" characteristics of ballet dance, and use of the 33% distal radius region for the accurate assessment of bone mineral status should be investigated further in this population.

Biomechanical analysis of injuries of rally driver with head supporting device.

PURPOSE: The aim of the study was to develop and verify a model of rally driver with a safety system HANS (head supporting device), which will enable biomechanical analysis of injuries in rally accident. METHODS: Simulations were carried out in Madymo® software, the results of which were verified based on sled test performed in the Automotive Industry Institute (PIMOT) in Warsaw. The model being verified allowed us to perform a multivariate simulation of rally accident in terms of assessing effectiveness of protection and usefulness of HANS system. RESULTS: Acceleration waveforms of the head and chest were obtained from numerical experiment and also forces and moments occurring in the upper cervical spine. The results obtained allowed driver injuries to be analyzed based on injury criteria of the head and neck: HIC15, NTE, NTF, NCE and NCF. CONCLUSIONS: The analysis enabled assessment of the driver safety while using 4 and 5 point harness with HANS system. In further studies the model developed was used to identify factors affecting the safety of a rally driver.

Experimental biomechanical assessment of plate stabilizers for treatment of pectus excavatum.

The paper discusses results of experimental research involving new generation of plate stabilizers used for the treatment of deformation of the front chest wall. Previous clinical monitoring revealed instances of minimal rotation, which caused destabilization of the anastomosis and pain in patients. In order to prevent this, transverse stabilizing plates were introduced to the structure of the stabilizer. The new structure of stabilizers was tested using two specially prepared research posts: 1 - which enables fastening of the plate stabilizers to a platform simulating human ribs, 2 - using a pig chest, to which plates were fastened according to the stabilization conditions in the stabilizer-chest structure. The tests recorded displacement values in selected areas of the plates in response to applied loading forces.

Engineering-aided treatment of chest deformities to improve the process of breathing.

In this paper, the application of new visualization technologies in correction of funnel chest is presented. Often, such defects cause problems with breathing, and therefore, to improve the cardiorespiratory efficiency, a correction is required. The virtual model of chest was formulated to determine the strains and stresses after correction of deformation with using the stabilizing plate. From biomechanical point of view, the knowledge of the load-affecting stabilizer is necessary to select optimal parameters of the plate. The force-affecting plate that was used in the correction of chest deformation by Nuss method was determined on the basis of finite element model of funnel chest. The main aim of this work was to select the optimal thickness of plate. Calculations were conducted for three alternative constraints.