Dynamic reconstruction of the philtrum using coronal muscle splitting technique in microform cleft lip.

PURPOSE: The philtral column and dimple are especially important in patients with cleft lip. Recently, we have found that, at maximal puckering, the appearance of the philtrum worsens although the philtral column is well formed at rest. In this study, we explore the effectiveness of the coronal muscle splitting technique in a microform cleft lip through comparative analysis of the postoperative results between the control group (patients without coronal muscle splitting) and the study group (patients with coronal muscle splitting). METHODS: Philtral reconstruction was performed in 24 patients with microform cleft lip between March 2006 and March 2010. The philtrum was reconstructed in 12 patients using the coronal muscle splitting technique and in the other 12 patients without this technique. The convexity of the philtral column and the dimpling of the philtrum were evaluated at rest and at maximal puckering through digital photographs and videos taken preoperatively and postoperatively. In addition, we compared the postoperative results between the 2 groups using the paired t-test. RESULTS: Postoperative evaluation was done at 6 to 48 months (mean, 25 mo). There was no statistically significant difference in the shape of the philtral column and the philtral dimple between the 2 groups preoperatively (P > 0.05). Reconstruction of the philtral column in the study group rendered better results than in the control group at both rest and maximal puckering (P < 0.001 and P < 0.001). Reconstruction of the philtral dimple in the study group rendered better results than in the control group at both rest and maximal puckering (P = 0.018 and 0.035). CONCLUSIONS: The coronal muscle splitting technique offers more esthetic and functional results in the formation of the philtral column and dimple both at rest and at maximal puckering than in the control group in cases of philtral reconstruction of the microform cleft lip.

White matter hyperintensities in subjects with bipolar disorder.

There have been divergent reports on the prevalence and severity of white matter hyperintensities (WMH) on brain magnetic resonance (MR) images in subjects with bipolar disorder. In the present study, evaluations were made on the prevalence and severity of WMH in subjects with bipolar disorder using contiguous 3-mm thick MR slices as well as fluid attenuated inversion recovery (FLAIR) images. A detailed WMH rating system was employed to assess these WMH. A total of 43 bipolar patients, as diagnosed by the Structured Clinical Interview from the Diagnostic and Statistical Manual-IV (SCID-IV), and 39 healthy comparison subjects were scanned using a 1.5-T whole body GE magnetic resonance scanner. WMH were assessed with a modified composite version of the Fazekas' and Coffey's rating scales to detect less severe WMH. Periventricular and subcortical WMH were coded separately. Subjects with bipolar disorder had greater prevalence of WMH abnormalities than comparison subjects (Bipolar, grade 1 = 11.6%, grade 2 = 9.3%, grade 3 = 7.0%; Comparison, grade 1 = 5.1%, grade 2 = 2.6%, grade 3 = 0%). This difference is mainly due to the differences in deep WMH (Bipolar, grade 1 = 14.0%, grade 2 = 14.0%; Comparison, grade 1 = 7.7%, grade 2 = 0%). The current study confirms the higher prevalence of WMH in subjects with bipolar disorder. Differences of small-sized WMH abnormalities between groups were successfully detected using a large number of bipolar subjects and thinner sliced MR images with FLAIR.