The effect of botulinum toxin A in unilateral cleft lip scar: comparison of results with different sites of injection.

Botulinum toxin type A (BTA) injections into the subjacent orbicularis oris muscle have been shown to improve appearance and produce narrower cheiloplasty scars. This study was performed to determine the effect of BTA injected at different sites on the unilateral cleft lip scar and cleft side nostril width. A double-blind, randomized prospective trial was conducted involving 64 consecutive patients with unilateral cleft lip undergoing primary cheiloplasty between September 2016 and January 2019. The patients were randomized to receive BTA injections either into the subjacent orbicularis oris muscle (4 points group) or into the bilateral nasolabial fold region (6 points group) during cheiloplasty. The scars were assessed by photographic scar width measurements and Vancouver scar scale assessment tool. The cleft side nostril width was compared to the non-cleft side width. Fifty-six patients completed the trial, 24 in the 4 points group and 31 in the 6 points group. There was no significant difference in scar width or nostril width measurements between the groups at the end of follow-up. The Vancouver scar scale assessment was also similar between the groups. There was no significant difference in scar width or nostril width measurements after cleft lip repair between patients treated with botulinum toxin injections to the subjacent orbicularis oris muscle and patients treated with injections in the nasolabial region.

Is skeletal stability after bimaxillary surgery for skeletal class III deformity related to surgical occlusal contact?

A stable occlusion at the time of surgery is considered important for post-surgical stability after orthognathic surgery. The aim of this study was to determine whether skeletal stability after bimaxillary surgery using a surgery-first approach for skeletal class III deformity is related to the surgical occlusal contact or surgical change. Forty-two adult patients with a skeletal class III deformity corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy with a surgery-first approach were studied. Dental models were set and used to measure the surgical occlusal contact, including contact distribution, contact number, and contact area. Cone beam computed tomography was used to measure the surgical change (amount and rotation) and post-surgical skeletal stability. The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated. No relationship was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant relationship was found between maxillary and mandibular stability and the amount and rotation of surgical change. The results suggest that in the surgical-orthodontic correction of skeletal class III deformity with a surgery-first approach, the post-surgical skeletal stability is not related to the surgical occlusal contact but is related to the surgical change.

Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty.

Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.

Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting.

Sixty-three consecutive patients undergoing bimaxillary surgery between June and August 2015 were included in this study. Twenty-one patients were included in each of three study groups. In group 1, sevoflurane was the sole maintenance anaesthesia agent used; in group 2, propofol was the predominant agent, in addition to a reduced amount of sevoflurane; in group 3, patients received sevoflurane until fixation was completed, at which point it was switched to propofol. The mean intraoperative blood loss (ml) was 707.14±290.74 in group 1, 917.62±380.30 in group 2, and 750.00±331.84 in group 3; the difference between groups 1 and 2 was significant (P=0.047). The mean score for the quality of surgical field assessment was 1.32±0.44 in group 1, 2.04±0.49 in group 2, and 1.45±0.53 in group 3 (P=0.003). The postoperative nausea and vomiting (PONV) rate was 28.6% in group 1, 9.5% in group 2, and 14.3% in group 3 (P=0.343). The quality of the surgical field was significantly better in groups 1 and 3 than in group 2. The average blood loss in group 1 was also significantly less than in group 2. The PONV rates were lower than those reported in other studies.

Novel synthesis of alkenes via triethylborane-induced free-radical reactions of alkyl iodides and beta-nitrostyrenes.

Reactions of (E)-beta-nitrostyrenes 1 and triethylborane 2 or tricyclohexylborane 4 in THF solution at room temperature in the presence of oxygen in the air as radical initiator generate high yields of trans-alkenes (E)-3 or (E)-5. Medium to high yields of different (E)-alkenes (E)-5, 7, 10, 12, and 14 also can be prepared when 1 reacts with different radicals, prepared from secondary alkyl iodides 6 and 8 or tertiary alkyl iodides 9, 11, and 13, in the presence of 2 and air as radical initiator. The generation of the only product (E)-alkenes can be explained by the generation of the benzylic radical A and/or B as the intermediate only and the mechanism is similar to Scheme 1. Both (E)- and (Z)-16a-c are generated when (E)- and (Z)-15a-c are used to react with adamantyl radical under similar conditions. Only (Z)-16d was observed when either (E)- or (Z)-15d was used to react with adamantyl radical. The generation of the (E)- and/or (Z)-alkenes can be explained by the free rotation of the A and/or B to generate A' and/or B' and vice versa, and the mechanism is proposed to be a free-radical reaction via NO2/alkyl substitution and is shown as Scheme 2.

An improved and easy method for the preparation of 2,2-disubstituted 1-nitroalkenes.

Reactions of ketones 1, nitromethane 2, and catalytic amount of piperidine 3 in the presence of mercaptan 6 generate beta-nitroalkyl sulfides 7-9. At 0 degrees C and by the use of dichloromethane as solvent, beta-nitroalkyl sulfides 7-9 can be oxidized by m-chloroperoxybenzoic acid (m-CPBA) 10 to generate beta-nitroalkyl sulfoxides 11-13 and undergo elimination in carbon tetrachloride solution to produce medium to high yield of 2,2-disubstituted 1-nitroalkenes 5. The irreversibility of the synthetic mechanism not only can overcome the reversibility of the Henry reaction in the synthesis of 2,2-disubstituted 1-nitroalkenes 5 but also can generate the major products "exo-nitro olefins"5c-e when cyclic ketones 1c-e were used. Under similar conditions, medium to high yield of 5-substituted-2-nitromethyl-2-phenylthioadamantane 17 also can be prepared from the reaction of 5-substituted-2-adamantanones 15, nitromethane 2, piperidine 3, thiophenol 6a. The intermediate17 can be oxidized by m-CPBA 10 in dichloromethane solution and then undergo elimination at room temperature or can be dissolved in solvent, coated on silica gel, and then heated at 90-100 degrees C to generate 5-substituted-2-nitromethyleneadamantane 16.