Changes in the upper airway and its surrounding structures after bimaxillary surgery in patients with cleft-related Class III deformity.

OBJECTIVES: To compare upper airway changes following bimaxillary surgery for correction of Class III deformity between patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the preoperative and postoperative upper airway among patients with UCLP and BCLP to healthy controls. MATERIALS AND METHODS: Sixty adults with CLP-related skeletal Class III deformity (30 UCLP and 30 BCLP) who consecutively underwent bimaxillary surgery were studied retrospectively. Cone-beam computed tomography (CBCT) was performed before and after surgery to measure upper airway and movements of facial skeletal and surrounding structures. CBCT images from 30 noncleft skeletal Class I adults, matched by age, gender, and body mass index and without surgical intervention, served as controls. RESULTS: After surgery, the volume of the nasopharynx increased in patients with CLP (both P < .001). Patients with CLP did not differ from controls in postoperative volume of the nasopharynx or oropharynx. However, the nasal cavity differed significantly between patients with CLP and controls (P < .001). CONCLUSIONS: After bimaxillary surgery, the nasal cavity of patients with CLP differed significantly compared with the controls. Volumes of the nasopharynx and oropharynx did not differ between patients with CLP after surgery and controls.

Genetic surveillance reveals low, sustained malaria transmission with clonal replacement in Sao Tome and Principe.

Despite efforts to eliminate malaria in Sao Tome and Principe (STP), cases have recently increased. Understanding residual transmission structure is crucial for developing effective elimination strategies. This study collected surveillance data and generated amplicon sequencing data from 980 samples between 2010 and 2016 to examine the genetic structure of the parasite population. The mean multiplicity of infection (MOI) was 1.3, with 11% polyclonal infections, indicating low transmission intensity. Temporal trends of these genetic metrics did not align with incidence rates, suggesting that changes in genetic metrics may not straightforwardly reflect changes in transmission intensity, particularly in low transmission settings where genetic drift and importation have a substantial impact. While 88% of samples were genetically linked, continuous turnover in genetic clusters and changes in drug-resistance haplotypes were observed. Principal component analysis revealed some STP samples were genetically similar to those from Central and West Africa, indicating possible importation. These findings highlight the need to prioritize several interventions such as targeted interventions against transmission hotspots, reactive case detection, and strategies to reduce the introduction of new parasites into this island nation as it approaches elimination. This study also serves as a case study for implementing genetic surveillance in a low transmission setting.

Analyzing urinary hippuric acid as a metabolic health biomarker through a supramolecular architecture.

The prevalence of metabolic disorders has been found to increase concomitantly with alternations in habitual diet and lifestyle, indicating the importance of metabolic health monitoring for early warning of high-risk status and suggesting effective intervention strategies. Hippuric acid (HA), as one of the most abundant metabolites from the gut microbiota, holds potential as a regulator of metabolic health. Accordingly, it is imperative to establish an efficient, sensitive, and affordable method for large-scale population monitoring, revealing the association between HA level and metabolic disorders. Upon systematic screening of macrocycle•dye reporter pair, a supramolecular architecture (guanidinomethyl-modified calix[5]arene, GMC5A) was employed to sense urinary HA by employing fluorescein (Fl), whose complexation behavior was demonstrated by theoretical calculations, accomplishing quantification of HA in urine from 249 volunteers in the range of 0.10 mM and 10.93 mM. Excitedly, by restricted cubic spline, urinary HA concentration was found to have a significantly negative correlation with the risk of metabolic disorders when it exceeded 0.76 mM, suggesting the importance of dietary habits, especially the consumption of fruits, coffee, and tea, which was unveiled from a simple questionnaire survey. In this study, we accomplished a high throughput and sensitive detection of urinary HA based on supramolecular sensing with the GMC5A•Fl reporter pair, which sheds light on the rapid quantification of urinary HA as an indicator of metabolic health status and early intervention by balancing the daily diet.

Site and severity of facial asymmetry after bimaxillary surgery for class III deformity: a case-control study.

OBJECTIVES: The study aimed (1) to evaluate the site and severity of facial asymmetry in Class III patients before and after bimaxillary surgery, and (2) to identify the influence of initial severity and positional jaw asymmetry on residual facial asymmetry. MATERIALS AND METHODS: Preoperative and postoperative cone-beam computed tomography of 65 patients with Class III facial asymmetry who underwent bimaxillary surgery were evaluated. Five midline and 14 paramedian facial soft tissue landmarks were identified to assess facial asymmetry. The outcomes were compared to a control group consisting of 30 age- and gender-matched Class I subjects. The postoperative positional jaw asymmetry (i.e., shift, roll, yaw) of each osteotomy segment (maxilla, mandible, chin, ramus) was also measured. RESULTS: Before surgery, the asymmetry was more severe at the chin, middle and lower contour. Bimaxillary surgery effectively corrected facial asymmetry, particularly in achieving normalization of chin deviation. However, significant asymmetry persisted postoperatively in the middle and lower contour (p < 0.001 and p < 0.01, respectively), which was affected by the positional ramus asymmetry in the roll and shift. CONCLUSIONS: Deviation of the chin, middle and lower contour contributed significantly to overall facial asymmetry in Class III asymmetry. Despite normalization of the chin deviation after bimaxillary surgery, asymmetry persisted at the middle and lower contour, primarily as the result of insufficient correction of the positional ramus asymmetry. CLINICAL RELEVANCE: Understanding the residual asymmetry after bimaxillary surgery is important for minimizing deviation and optimizing the surgical planning for its correction.

Single Molecular Nanomedicines Based on Macrocyclic Carrier-Drug Conjugates for Concentration-Independent Encapsulation and Precise Activation of Drugs.

Nanomedicines often rely on noncovalent self-assembly and encapsulation for drug loading and delivery. However, challenges such as reproducibility issues due to the multicomponent nature, off-target activation caused by premature drug release, and complex pharmacokinetics arising from assembly dissociation have hindered their clinical translation. In this study, we introduce an innovative design concept termed single molecular nanomedicine (SMNM) based on macrocyclic carrier-drug conjugates. Through the covalent linkage of two chemotherapy drugs to a hypoxia-cleavable macrocyclic carrier, azocalix[4]arene, we obtained two self-included complexes to serve as SMNMs. The intramolecular inclusion feature of the SMNMs has not only demonstrated comprehensive shielding and protection for the drugs but also effectively prevented off-target drug leakage, thereby significantly reducing their side effects and enhancing their antitumor therapeutic efficacy. Additionally, the attributes of being a single component and molecularly dispersed confer advantages such as ease of preparation and good reproducibility for SMNMs, which is desirable for clinical applications.

Sulfonated Azocalix[4]arene-Modified Metal-Organic Framework Nanosheets for Doxorubicin Removal from Serum.

Chemotherapy is one of the most commonly used methods for treating cancer, but its side effects severely limit its application and impair treatment effectiveness. Removing off-target chemotherapy drugs from the serum promptly through adsorption is the most direct approach to minimize their side effects. In this study, we synthesized a series of adsorption materials to remove the chemotherapy drug doxorubicin by modifying MOF nanosheets with sulfonated azocalix[4]arenes. The strong affinity of sulfonated azocalix[4]arenes for doxorubicin results in high adsorption strength (Langmuir adsorption constant = 2.45-5.73 L mg-1) and more complete removal of the drug. The extensive external surface area of the 2D nanosheets facilitates the exposure of a large number of accessible adsorption sites, which capture DOX molecules without internal diffusion, leading to a high adsorption rate (pseudo-second-order rate constant = 0.0058-0.0065 g mg-1 min-1). These adsorbents perform effectively in physiological environments and exhibit low cytotoxicity and good hemocompatibility. These features make them suitable for removing doxorubicin from serum during "drug capture" procedures. The optimal adsorbent can remove 91% of the clinical concentration of doxorubicin within 5 min.

Effect of mydriasis on macular and peripapillary metrics in swept-source optical coherence tomography angiography.

Introduction: The study aimed to evaluate the effect of mydriasis on macular and peripapillary metrics with swept-source optical coherence tomography angiography (SS-OCTA) in healthy subjects. Methods: Thirty-five healthy subjects were included. The macular region was scanned by the 3×3mm mode and 6×6mm mode, and the peripapillary region was scanned by the 4.5×4.5mm mode on both eyes with SS-OCTA before and after mydriasis. Macular and peripapillary metrics, including retinal vessel density (VD) and fundus thickness were measured by the built-in program. Data of the right eye were analyzed. Results: The signal strength of the scans was comparable before and after mydriasis (all P>0.05). There were no significant differences in foveal avascular zone (FAZ) parameters and retinal VD of most sectors in both macular and peripapillary areas (all P>0.05). Choroidal thickness was decreased, outer and whole retinal thickness was increased in most of the macular sectors after mydriasis (all P<0.05). Choroidal thickness was decreased in all the peripapillary sectors, but whole retinal thickness and GCC thickness were increased in some peripapillary sectors after mydriasis (all P<0.05). Conclusions: FAZ parameters and retinal VD in the most macular and peripapillary regions are not affected by mydriasis. The thickness of the choroid is decreased after mydriasis, while the thickness of retinal layers in some sectors may be increased after mydriasis.

Three-dimensional facial soft-tissue changes after surgical orthodontics in different vertical facial types of skeletal Class III malocclusion: A retrospective study.

The study compared the soft-tissue response to hard-tissue movement among different Class III vertical facial types after orthognathic surgery (OGS). The study included 90 consecutive adult patients with skeletal Class III malocclusion who underwent two-jaw OGS. Patients were divided into three groups (high, medium, and low angle) based on the presurgical Frankfort-mandibular plane angle. Cone-beam computerized tomographs were taken before surgery and after debonding. Soft- and hard-tissue linear and angular measurements were performed using three-dimensional reconstruction images. One-way analysis of variance was used for intergroup comparisons. Soft tissue tended to respond more to hard-tissue movement in the lower lip area in patients with low angle (mean = 0.089, SD = 0.047, p = 0.023), whereas no significant difference was observed for other sites. Consistently, L1/Li thickness increased most significantly in the high-angle group (mean = 1.98, SD = 2.14, p = 0.0001), and B/Si thickness decreased most significantly after surgery (mean = 2.16, SD = 2.68, p = 0.016). The findings suggest that the high-angle group had a higher chance of undergoing genioplasty to enhance chin contour. Different OGS plans should be considered for different Class III vertical facial types.

Three-dimensional positioning of the maxilla using novel intermediate splints in maxilla-first orthognathic surgery for correction of skeletal class III deformity.

OBJECTIVES: Successful orthognathic surgery requires accurate transfer of the intraoperative surgical plan. This study aimed to (1) evaluate the surgical error of a novel intermediate splint in positioning the maxilla during maxilla-first orthognathic surgery and (2) determine factors influencing surgical error. MATERIALS AND METHODS: This prospective study examined 83 patients who consecutively underwent Le Fort I osteotomy for correction of skeletal class III deformity using a novel intermediate splint and a bilateral sagittal split osteotomy. Surgical error was the outcome variable, measured as the difference in postoperative translational and rotational maxillary position from the virtual plan. Measures included asymmetry, need and amount for mandibular opening during fabrication of intermediate splints, and planned and achieved skeletal movement. RESULTS: Mean errors in translation for vertical, sagittal, and transversal dimensions were 1.0 ± 0.7 mm, 1.0 ± 0.6 mm, and 0.7 ± 0.6 mm, respectively; degrees in rotation for yaw, roll, and pitch were 0.8 ± 0.6, 0.6 ± 0.4, and 1.6 ± 1.1, respectively. The transverse error was smaller than sagittal and vertical errors; error for pitch was larger than roll and yaw (both p < 0.001). Error for sagittal, transverse, and roll positioning was affected by the achieved skeletal movement (roll, p < 0.05; pitch and yaw, p < 0.001). Surgical error of pitch positioning was affected by planned and achieved skeletal movement (both p < 0.001). CONCLUSIONS: Using the novel intermediate splint when performing Le Fort I osteotomy allowed for accurate positioning of the maxilla. CLINICAL RELEVANCE: The novel intermediate splint for maxillary positioning can be reliably used in clinical routines.

Three-dimensional evaluation of skeletal stability after surgery-first bimaxillary surgery for class III asymmetry in 70 consecutive patients.

Background/purpose: Skeletal stability after orthognathic surgery is essential for positive treatment outcome. This study evaluated the stability of osteotomy segments after surgery-first bimaxillary surgery for class III asymmetry. Materials and methods: Seventy adults with class III asymmetry consecutively corrected through surgery-first Le Fort I and bilateral sagittal split osteotomies were investigated. Cone-beam computed tomography before treatment (T0), 1-week after surgery (T1), and after all treatment (T2, ≥1-year after surgery) was used to assess surgical movement (T0 to T1) and skeletal stability (T1 to T2) regarding the translation and rotation of the maxillary, mandibular distal, and proximal segments. Results: At T1, the maxillary segment had moved forward and upward, turned to the deviated side, and rotated downward (all P < 0.01). The distal segment of mandible had moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment had moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment had moved upward and tilted to the deviated side (both P < 0.01). At T2, significant relapse occurred in the mandible. The distal segment moved forward and upward and rotated upward (all P < 0.001). The deviated proximal segment moved upward, tilted to the opposite side, and rotated upward (all P < 0.001). The opposite proximal segment moved upward and tilted to the deviated side (both P < 0.01). Conclusion: Clinically significant relapse of class III asymmetry was discovered on the mandibular distal and opposite proximal segments.

Chang Gung Forum: An Exemplary Strategy for Implementing a Multidisciplinary Network of Experts in Craniofacial Anomalies.

INTRODUCTION: The Chang Gung Forum has been dedicated to the care of craniofacial anomalies since 2000. This annual continuing medical education program focuses on orofacial cleft and surgery-first orthognathic surgery by providing up-to-date information and management guidelines. This study explored how the Chang Gung Forum has influenced medical perspectives, decisions, and practices in a multidisciplinary craniofacial team. METHODS: Between 2000 and 2022, 20 Chang Gung Forums have been held. A questionnaire was distributed among 170 attendees who had participated in the forum more than once. The questionnaire collected information on the participants' experiences and levels of satisfaction with the educational program and whether or how it had influenced their clinical practice. RESULTS: Valid responses from 86 attendees (response rate, 50.6%) who had participated more than once were collected and analyzed. The overall satisfaction rate of the Chang Gung Forum based on the respondents' most recent visits was 4.28 ± 0.63 out of 5. Of the respondents, 90.9% acknowledged changes in their clinical practice, with modifications in surgery plans and decisions being the most notable (48.5%). In addition, comprehension increased throughout years of attending the annual forum (P < 0.001). CONCLUSION: The Chang Gung Forum has contributed markedly to the community of congenital craniofacial anomalies. The program will continue providing updated information and influencing the clinical decision-making of health care professionals.

Surgery-First Orthognathic Approach for Correction of Dentofacial Deformity in Unilateral Cleft Lip and Palate.

BACKGROUND: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. METHODS: Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. RESULTS: A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. CONCLUSION: These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Preparation,characterization,and in vitro biological performance evaluation of PLGA electrospinning membranes doped with metformin-loaded hollow mesoporous silica nanoparticles / 实用口腔医学杂志

Objective:To prepare PLGA electrospinning membranes doped with hollow mesoporous silica nanoparticles loaded with metformin and investigate their biological properties.Methods:PLGA(Control group)and PLGA/HMSN/Met electrospun membranes(Experimental group)were prepared by electrospinning technology.The microscopic morphology of the 2 groups of electrospun mem-branes was observed by SEM.The hydrophilicity,elemental composition and in vitro drug release were detected by contact angle meas-urement,EDS,and drug release test,respectively.SEM and laser scanning confocal microscope(LSCM)were used to observe the growth of periodontal ligament stem cells(PDLSCs)on the 2 groups of electrospun membranes,and CCK-8 assay was used to detect the cell proliferation.Results:Both electrospun membranes had extracellular matrix(ECM)-like fiber structures.The PLGA/HMSN/Met electrospun membranes could slowly release Met for up to 35 days,and the hydrophilicity of PLGA membranes was improved by HMSN-Met doped.The composite electrospun membranes had good cell biocompatibility in vitro,and could promote cell proliferation.Conclu-sion:Modification of PLGA with HMSN-Met can improve the hydrophilicity of PLGA electrospun membranes,continuously release Met,and have good cell biocompatibility.

Four new additions to Helvella (Helvellaceae, Pezizales) from Northern Thailand.

Most species of Helvella have been described from temperate regions in Asia, Europe, and North America, but little is known about the genus from tropical regions. In this report, phylogenetic analyses of 11 newly collected saddle-like fungi from northern Thailand using three genetic markers [the nuclear large subunit ribosomal DNA (LSU), the heat shock protein 90 (HSP90), and the translation elongation factor 1-alpha (TEF)] confirm their assignment in Helvella. Two species were described as new, i.e., Helvella atroides and H. orentitomentosa, and two species, i.e., H. fistulosa and H. rugosa, were reported for the first time in Thailand. Details of macro- and microscopic characters and illustrations were provided for each species. To date, seven species of Helvella have been recorded in Thailand, and a key for identifying the Thai Helvella species was provided here.

Surgical occlusion setup and skeletal stability of correcting cleft-associated class III deformity using surgery-first bimaxillary surgery.

BACKGROUND: This study aimed to assess the three-dimensional (3D) quantitative characteristics of the surgical occlusion setup in surgery-first cleft orthognathic surgery, and to evaluate its influence on post-surgical skeletal stability. METHODS: This prospective study was comprised of 35 patients with unilateral cleft lip and palate and class III deformity who consecutively underwent two-jaw surgery with surgery-first approach. Digitized dental models were analyzed to quantify the 3D characteristics of the final surgical occlusion setup. Cone-beam computed tomography was used to measure the 3D surgical skeletal movement and post-surgical skeletal stability. The correlation between skeletal stability and surgical occlusal contact or surgical skeletal movement was also evaluated. RESULTS: The surgical occlusion setup had a large incisor overjet and positive overbite, and buccal cross bite and open bite on second molars. Occlusal contact on three segments was present in 51.4% of the patients, and the average number for tooth contact was 4.3 teeth. No correlation was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant correlation was found between maxillary and mandibular stability and the surgical skeletal movement. CONCLUSIONS: The surgical occlusion for correction of cleft-associated class III deformity using the surgery-first approach was characterized with large overjet and positive overbite, and posterior cross bite and open bite. On average, there was occlusal contact on four to five teeth; half of surgical occlusion setups had contact on three segments. The post-surgical skeletal stability was not related to the surgical occlusal contact but to the surgical skeletal movement.

The complete chloroplast genome of Rubus pinfaensis, an edible and medicinal dual-purpose plant.

Rubus pinfaensis H. Lév. & Vaniot is of great importance in the phylogeny and evolution amongst Rosaceae, genus Rubus L. plants. The chloroplast genome of R. pinfaensis was reported in this study, which is 155,523 bp in size, with an average GC content of 37.13%. The complete chloroplast genome has a typical quadripartite structure, including a large single copy (LSC) region (85,211 bp) and a small single copy (SSC) region (18,718 bp), which were separated a pair of inverted repeats (IRs, 25,797 bp). This plastome contained 129 different genes (112 unique), including 85 protein-coding genes (79 unique), 36 tRNA genes (29 unique), and 8 rRNA genes (4 unique). The chloroplast genome of R. pinfaensis has completed that will be based on the phylogeny and genomic studies in the family Rosaceae, genus Rubus L.

Indoor CO2 monitoring in a surgical intensive care unit under visitation restrictions during the COVID-19 pandemic.

Background: Indoor CO2 concentration is an important metric of indoor air quality (IAQ). The dynamic temporal pattern of CO2 levels in intensive care units (ICUs), where healthcare providers experience high cognitive load and occupant numbers are frequently changing, has not been comprehensively characterized. Objective: We attempted to describe the dynamic change in CO2 levels in the ICU using an Internet of Things-based (IoT-based) monitoring system. Specifically, given that the COVID-19 pandemic makes hospital visitation restrictions necessary worldwide, this study aimed to appraise the impact of visitation restrictions on CO2 levels in the ICU. Methods: Since February 2020, an IoT-based intelligent indoor environment monitoring system has been implemented in a 24-bed university hospital ICU, which is symmetrically divided into areas A and B. One sensor was placed at the workstation of each area for continuous monitoring. The data of CO2 and other pollutants (e.g., PM2.5) measured under standard and restricted visitation policies during the COVID-19 pandemic were retrieved for analysis. Additionally, the CO2 levels were compared between workdays and non-working days and between areas A and B. Results: The median CO2 level (interquartile range [IQR]) was 616 (524-682) ppm, and only 979 (0.34%) data points obtained in area A during standard visitation were ≥ 1,000 ppm. The CO2 concentrations were significantly lower during restricted visitation (median [IQR]: 576 [556-596] ppm) than during standard visitation (628 [602-663] ppm; p < 0.001). The PM2.5 concentrations were significantly lower during restricted visitation (median [IQR]: 1 [0-1] µg/m3) than during standard visitation (2 [1-3] µg/m3; p < 0.001). The daily CO2 and PM2.5 levels were relatively low at night and elevated as the occupant number increased during clinical handover and visitation. The CO2 concentrations were significantly higher in area A (median [IQR]: 681 [653-712] ppm) than in area B (524 [504-547] ppm; p < 0.001). The CO2 concentrations were significantly lower on non-working days (median [IQR]: 606 [587-671] ppm) than on workdays (583 [573-600] ppm; p < 0.001). Conclusion: Our study suggests that visitation restrictions during the COVID-19 pandemic may affect CO2 levels in the ICU. Implantation of the IoT-based IAQ sensing network system may facilitate the monitoring of indoor CO2 levels.

Outcomes of alveolar cleft repair in complete cleft lip and palate after tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy.

OBJECTIVES: Gingivoperiosteoplasty is often used for reconstruction of alveolar defects in infants with cleft lip and palate. This study aimed to examine outcomes of tertiary gingivoperiosteoplasty, which has not previously been investigated. MATERIALS AND METHODS: This prospective study included 11 adults with complete cleft lip and palate (n = 12 sites) who consecutively underwent segmental Le Fort I osteotomy and concomitant gingivoperiosteoplasty for correction of skeletal class III deformity, nasoalveolar fistula and alveolar cleft. Outcomes included clinical and radiographic evaluations of gingivoperiosteoplasty at the time of osteotomy (presence of nasoalveolar fistula, residual cleft defect and unsupported root ratio of cleft-adjacent teeth), and determination of influencing factors for the clinical success of alveolar cleft repair. Study variables included age, gender, pre-surgical orthodontic treatment and alveolar cleft width of cleft-adjacent canine and angulation between cleft-adjacent teeth before surgery and 1-week postsurgery. RESULTS: Posttreatment, no nasoalveolar fistula remained. The residual cleft defect decreased significantly (p < 0.01). The unsupported root ratio of cleft-adjacent teeth did not differ (p > 0.05); eight cleft sites reached Bergland I or II (67% success). One-week postsurgery, the minimal alveolar cleft width of cleft-adjacent canine was significantly less in the success group compared with the failed group (p = 0.01). CONCLUSIONS: Tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy decreased nasoalveolar fistulas and induced alveolar bone formation. The minimal alveolar cleft width immediately after surgery was the major influencing factor of clinical success. CLINICAL RELEVANCE: Segmental Le Fort I osteotomy with simultaneous gingivoperiosteoplasty efficaciously repairs adult alveolar clefts.