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The Cleft Palate-craniofacial Journal :... Sep 2023To assess parents' satisfaction with cleft child's facial appearance and function; compare these findings with orthodontist (expert) satisfaction and evaluate influence...
To assess parents' satisfaction with cleft child's facial appearance and function; compare these findings with orthodontist (expert) satisfaction and evaluate influence of various factors on satisfaction. Cross-sectional study. Sixty-three parents of non-syndromic patients with clefts (ages 7-20 years), and an orthodontist, completed the Cleft Hearing, Appearance and Speech Questionnaire. Two scores were produced: cleft-associated, and non-cleft-associated features. Additional open questions were presented to the parents. Both parents and orthodontist gave high satisfaction scores (mean: 8.4 & 8.2, respectively), significantly correlated, for the cleft-associated features ( < .001). Parents were least satisfied with appearance of teeth, then nose, then lips. Scores did not vary significantly with age and sex of patients. Higher parents' satisfaction was found in the unilateral cleft lip + alveolus (UCL + alveolus) group, compared with the unilateral cleft lip and palate (UCLP), regarding cleft-associated features, and compared with cleft palate (CP), regarding non-cleft-associated features ( < .05). Greater parents and orthodontist satisfaction were found when parents' education was >12 years. Parents of Jewish ethnicity showed higher satisfaction, compared with parents of non-Jewish ethnicity. Patients requiring future surgery received lower scores. Parents satisfaction was directly correlated to socioeconomic status. The following factors appear to lower parents' satisfaction: [1] cleft severity, [2] hearing or speech of CP/BCLP patients, [3] requirement for further surgery, and [4] low socioeconomic status. Severe cases may require additional explanation to parents in order to lower expectations. A more thorough explanation may be required in patients of lower socioeconomic status.
Topics: Child; Humans; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Patient Satisfaction; Personal Satisfaction; Adolescent; Young Adult; Male; Female
PubMed: 35469455
DOI: 10.1177/10556656221093934 -
Respirology (Carlton, Vic.) Sep 2023
Topics: Humans; Bronchoscopy; Respiratory System
PubMed: 37408089
DOI: 10.1111/resp.14547 -
APL Bioengineering Sep 2023We present a microvascular model of fluid transport in the alveolar septa related to pulmonary edema. It consists of a two-dimensional capillary sheet coursing by...
We present a microvascular model of fluid transport in the alveolar septa related to pulmonary edema. It consists of a two-dimensional capillary sheet coursing by several alveoli. The alveolar epithelial membrane runs parallel to the capillary endothelial membrane with an interstitial layer in between, making one long septal tract. A coupled system of equations uses lubrication theory for the capillary blood, Darcy flow for the porous media of the interstitium, a passive alveolus, and the Starling equation at both membranes. Case examples include normal physiology, cardiogenic pulmonary edema, acute respiratory distress syndrome (ARDS), hypoalbuminemia, and effects of PEEP. COVID-19 has dramatically increased ARDS in the world population, raising the urgency for such a model to create an analytical framework. Under normal conditions fluid exits the alveolus, crosses the interstitium, and enters the capillary. For edema, this crossflow is reversed with fluid leaving the capillary and entering the alveolus. Because both the interstitial and capillary pressures decrease downstream, the reversal can occur within a single septal tract, with edema upstream and clearance downstream. Clinically useful solution forms are provided allowing calculation of interstitial fluid pressure, crossflows, and critical capillary pressures. Overall, the interstitial pressures are found to be significantly more positive than values used in the traditional physiological literature. That creates steep gradients near the upstream and downstream end outlets, driving significant flows toward the distant lymphatics. This new physiological flow provides an explanation to the puzzle, noted since 1896, of how pulmonary lymphatics can function so far from the alveoli: the interstitium is self-clearing.
PubMed: 37426383
DOI: 10.1063/5.0158324 -
The Journal of Craniofacial Surgery Jun 2024The innovative technique of "presurgical lip, alveolus, and nose approximation" (PLANA) offers a new approach within the domain of presurgical infant orthopedics for...
The innovative technique of "presurgical lip, alveolus, and nose approximation" (PLANA) offers a new approach within the domain of presurgical infant orthopedics for infants born with cleft lip and palate. Presurgical lip, alveolus, and nose approximation introduces the utilization of the NoseAlign device in conjunction with medical adhesive tapes, designed to approximate and support displaced soft tissue nasolabial structures in patients with cleft, without an intraoral plate. The NoseAlign device, constructed from medical-grade silicone, consists of 2 tubular portions that fit into the nostrils, connected by a columella band. Notably, it also features a wave-shaped and curved horizontal lip band, resting on the upper lip, with elastic clasps for secure attachment to the face with medical adhesive tapes. Presurgical lip, alveolus, and nose approximation therapy employs the NoseAlign device to support the collapsed nasal alar rim and cartilage, the displaced columella, the deviated nasal septum, and the displaced nasal alar base. This innovative approach minimizes the need for frequent office visits, making it particularly suitable for patients residing at a distance from specialized cleft centers. The prefabricated NoseAlign device offers effective support to nasal structures, making it suitable for unilateral and bilateral clefts. Importantly, the absence of an intraoral plate ensures it does not interfere with feeding. Presurgical lip, alveolus, and nose approximation therapy, initiated as early as 1 to 2 weeks, leverages the plasticity of nasal soft tissue and cartilage to achieve the desired nasal form before primary surgery. Although presurgical lip, alveolus, and nose approximation therapy does have some limitations, particularly in cases of medially collapsed alveolar segments, its simplicity, universal applicability, and patient-friendliness make it a promising technique in the presurgical infant orthopedics field.
Topics: Humans; Cleft Lip; Cleft Palate; Infant; Alveolar Process; Nose; Rhinoplasty; Infant, Newborn; Male; Female; Preoperative Care
PubMed: 38587370
DOI: 10.1097/SCS.0000000000010107 -
British Dental Journal May 2024Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study...
Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study aims to examine dental injuries sustained during the two years following initiation of the trial.Methods The research was conducted at a UK, Level 1, supra-regional major trauma centre. All eligible patient records were analysed to identify e-scooter-related dental injuries to the following regions: teeth, periodontium, alveolus, palate, tongue, floor of mouth, frenum, buccal mucosa and lips. To assess significant associations between recorded variables, a Pearson's chi-square test was utilised.Results Of the 32 patients who experienced a total of 71 dental injuries, 46.5% (n = 33) affected teeth, predominantly upper central incisors (n = 17). 'Lacerations' (n = 32) and 'lips' (n = 30) were the most common type and site of soft tissue injuries, respectively. Unprovoked falls by riders accounted for 53.1% (n = 17) of the injuries. There was an overall increase in e-scooter-related dental injuries throughout the two-year period.Conclusion E-scooters have introduced an additional source of dental trauma. It is imperative health care professionals can also identify signs of head and non-dental injuries when managing such patients. Further studies are warranted allowing for better informed and optimised dental public health interventions.
PubMed: 38693336
DOI: 10.1038/s41415-024-7345-4 -
Annals of Surgery Apr 2024We propose the first classification scheme for macroglossia in patients with Beckwith-Wiedemann Syndrome (BWS), the BWS Index of macroGlossia (BIG).
OBJECTIVE/ SUMMARY BACKGROUND DATA
We propose the first classification scheme for macroglossia in patients with Beckwith-Wiedemann Syndrome (BWS), the BWS Index of macroGlossia (BIG).
METHODS
Patients with molecularly confirmed BWS seen from 2004-2023 were included to develop this system. Relationships among BIG scores, tongue reduction surgery, BWS clinical score, percent mosaicism, and polysomnography findings were examined.
RESULTS
Patients were classified from BIG0 to BIG3. BIG0 includes those without macroglossia; BIG1 includes those with macroglossia not protruding beyond the teeth/alveolus; BIG2 includes those with tongue protrusion past the teeth/alveolus to the lips but that can be contained within the mouth; and BIG3 includes those with tongues that protrude beyond the teeth/alveolus and lips but that cannot be closed within the mouth. Of the 459 patients with molecularly confirmed BWS, 266 (58.0%) patients were scored. One hundred and eleven (41.7%) were BIG0, 44 (16.5%) were BIG1, 90 (33.8%) were BIG2, and 21 (7.9%) were BIG3. As scores increased, patients had an increased incidence of tongue reduction surgery (BIG0: 0% versus BIG1: 20.5% versus BIG2: 51.1% versus BIG3: 100%; r=0.66, P <0.01). Higher BIG scores were associated with elevated BWS clinical scores (r=0.68, P <0.01) and increased tissue mosaicism (r=0.50, P <0.01) as well as trends towards worse obstructive apnea-hypopnea indices (r=0.29, P =0.02) and lower SpO 2 nadirs (r=-0.29, P =0.02).
CONCLUSION
In this large series of patients with Beckwith-Wiedemann Syndrome, increased BIG score correlates with undergoing tongue reduction surgery and increased phenotypic severity. Adoption of the BIG scoring system may facilitate communication and risk stratification across institutions.
PubMed: 38647147
DOI: 10.1097/SLA.0000000000006301 -
Journal of Oral and Maxillofacial... Aug 2023Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to evaluate the effectiveness of autogenous bone graft from the chin in the reconstruction of cleft alveolus.
METHODS
Searches were performed in six databases (PubMed, Scopus, Cochrane, LILACS, Embase, and Google Scholar) by two researchers individually until July 2022. This study was registered in the International Prospective Register of Systematic Reviews (CRD42021267954) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The predictor variable is reconstruction technique, grouped into three levels: autogenous genial grafts, other endochondral autogenous grafts, and bio- or tissue-engineered materials. The outcome variables were alveolar cleft healing rate and bone height. The secondary variables were complications that included infections, necrosis, paresthesia, and dehiscence. Data analysis included the risk of bias and assessment of the certainty of evidence by the risk of bias in nonrandomized studies of interventions and grading of recommendations, assessment, development, and evaluation tools, respectively. The meta-analysis was performed with heterogeneity based on random effects of I and 95% confidence.
RESULTS
In the initial search, 4,833 articles were found, and 10 of them were included in this systematic review. The included studies were from six countries on three different continents, with a sample of 692 patients. It was observed that the chin bone graft (214 patients) when compared to the endochondral bone graft (386 patients) reduced by 0.42 [confidence interval 95% = 0.18, 0.95] times the prevalence of bone resorption (P = .040 and I = 70%) analyzed in radiographic images. Two studies evaluated the bone filling through computed tomography, and there was no statistically significant difference between the groups (P = .340, I = 0%). Only two studies had a low risk of bias.
CONCLUSION
Based on a low certainty of evidence, the chin autogenous bone graft proved to be similar to the endochondral graft in the reconstruction of the cleft alveolar; however, the limited number of studies with high heterogeneity and an uncertain risk of bias decreased the strength of the results found in this systematic review. New controlled primary studies should be carried out with the purpose of safely determining the effectiveness of chin bone grafts for the reconstruction of cleft alveolar.
Topics: Humans; Bone Transplantation; Chin; Surgery, Plastic; Cleft Palate; Algorithms
PubMed: 37182542
DOI: 10.1016/j.joms.2023.04.011 -
Odontology Oct 2023Bone metabolism and repair are directly regulated by arachidonic acid metabolites. At present, we analyzed the dose-response effects of a selective cysteinyl leukotriene...
Bone metabolism and repair are directly regulated by arachidonic acid metabolites. At present, we analyzed the dose-response effects of a selective cysteinyl leukotriene receptor type-1 antagonist during bone repair after tooth extraction and on non-injured skeleton. Sixty-three 129 Sv/Ev male mice composed the groups: C-Control (saline solution); MTK2-2 mg/Kg of Montelukast (MTK) and MTK4-4 mg/Kg of MTK, daily administered by mouth throughout all experimental periods set at 7, 14, and 21 days post-operative. Dental sockets were analyzed by computed microtomography (microCT), histopathology, and immunohistochemistry. Femurs, L5 vertebra and organs were also removed for observation. Blood was collected for plasma bone and liver markers. Histopathology and microCT analysis revealed early socket repair of MTK2 and MTK4 animals, with significant increased BV/TV at days 14 and 21 compared to C. Higher plasma calcium was detected at days 7 and 21 in MTK4 in comparison to C, while phosphate was significantly increased in MTK2 in the same periods in comparison to C and MTK4. No significant differences were found regarding plasma ALP and TRAP, neither for local TRAP and Runx2 immunolabeling at the healing sockets. Organs did not present histological abnormalities. Increased AST levels have been detected in distinct groups and periods. In general, femur phenotype was improved in MTK treated animals. Collectively, MTK promoted early bone formation after tooth extraction and increased bone quality of femurs and vertebra in a time-dose-dependent manner, and should be considered as an alternative therapy when improved post-extraction socket repair or skeleton preservation is required.
Topics: Male; Mice; Animals; Tooth Socket; Wound Healing; Tooth Extraction; Acetates
PubMed: 36920595
DOI: 10.1007/s10266-023-00800-5 -
Journal of Oral and Maxillofacial... Mar 2024Success rates for alveolar bone grafting range from 30 to 96%. There is limited information regarding the success of repeat grafts.
BACKGROUND
Success rates for alveolar bone grafting range from 30 to 96%. There is limited information regarding the success of repeat grafts.
PURPOSE
The purpose of this study was to determine the radiographic success rate of repeat alveolar bone grafts.
STUDY DESIGN
The study designs was a retrospective cohort study of patients who underwent repeat grafting by 1 surgeon over 15 years. To be included, subjects had to have: cleft lip and alveolus and a cone-beam computed tomography (CBCT) scan obtained >6 months after repeat graft. Patients were excluded if CBCT was inadequate.
PREDICTOR VARIABLE
Predictor variables were sex, age at repeat graft, cleft type, presence of an erupted canine, premaxillary osteotomy at time of repeat graft, presence of a visible oronasal fistula, size of bony defect, presence of a bony palatal bridge, and whether the surgeon who performed the repeat graft also performed the initial graft.
MAIN OUTCOME VARIABLE
The outcome variable was graft success determined using CBCT assessment and defined as a score of >3 out of 4 in each domain: vertical bone level, labiopalatal thickness, and piriform symmetry.
COVARIATES
The covariates were time from bone graft to CBCT (months) and age at time of CBCT (years).
ANALYSES
Frequency distributions, relative risk with 95% confidence intervals, medians, and interquartile ranges were calculated. Pearson c2 and Fisher exact tests were performed to determine predictors of outcome. A P < .05 was considered statistically significant.
RESULTS
Fifty subjects (54% male) who had repeat bone grafting to 59 cleft sites were included. Median follow-up time from repeat graft to CBCT was 7.0 months (interquartile range: 5.9 months). The radiographic success rate was 81.4%:91.7% if the same surgeon performed both initial and repeat grafts, but 78.7% if initial graft was completed by another surgeon (P = .43).
CONCLUSION AND RELEVANCE
Despite being a multifactorial issue, extensive and bilateral clefts, the presence of an erupted tooth in the cleft area, a visible oronasal fistula, and concomitant osteotomy of the premaxilla are warning signs of the possibility of failure. Performing repeat alveolar bone grafting by an experienced surgeon appears to increase the chance of success.
Topics: Humans; Male; Female; Alveolar Bone Grafting; Cleft Palate; Retrospective Studies; Cleft Lip; Bone Transplantation; Fistula; Treatment Outcome
PubMed: 38040028
DOI: 10.1016/j.joms.2023.11.009 -
Journal of Plastic, Reconstructive &... Aug 2023Although childhood obesity matters, the association between body mass index (BMI) and bone mineral density (BMD) progression in grafted tissue after secondary alveolar...
BACKGROUND
Although childhood obesity matters, the association between body mass index (BMI) and bone mineral density (BMD) progression in grafted tissue after secondary alveolar bone grafting (ABG) for children with cleft alveolus is scarcely studied. Accordingly, this study explored the influence of BMI on BMD progression after ABG.
METHODS
In total, 39 patients with cleft alveolus receiving ABG at the mixed dentition stage were enrolled. Patients were classified as underweight, normal weight, or overweight or obese according to age- and sex-adjusted BMI. BMD was measured in Hounsfield units (HU) from cone-beam computed tomography scans obtained 6 months (T1) and 2 years (T2) postoperatively. Adjusted BMD (HU/HU, BMD) was used for further analysis.
RESULTS
For underweight, normal-weight, and overweight or obese patients, BMD values were 72.87%, 91.85%, and 92.89%, respectively (p = 0.727); BMD values were 111.49%, 112.57%, and 113.10% (p = 0.828); and density enhancement rates were 29.24%, 24.61%, and 22.14% (p = 0.936). No significant correlation was observed between BMI and BMD, BMD, or density enhancement rates (p = 0.223, 0.156, and 0.972, respectively). For patients with BMI < 17 and ≥ 17 kg/m, BMD values were 89.80% and 92.89%, respectively (p = 0.496); BMD values were 111.49% and 113.10% (p = 0.216); and density enhancement rates were 23.06% and 26.39% (p = 0.573).
CONCLUSION
Patients with different BMI values had similar outcomes (BMD, BMD, or density enhancement rate) after our ABG procedure in the 2-year postoperative follow-up.
Topics: Humans; Child; Alveolar Bone Grafting; Body Mass Index; Bone Density; Overweight; Cleft Palate; Thinness; Pediatric Obesity; Cleft Lip
PubMed: 37302245
DOI: 10.1016/j.bjps.2023.04.001