Muscle Flap Reconstruction Based on Muscle Tension Line Groups to Repair the Philtrum of Patients With Microform Cleft Lip or Secondary Cleft Lip.

ABSTRACT: The muscle flap reconstruction technique was developed based on the concept of muscle tension line groups, which elucidates how nasolabial muscle tension helps maintain the shape of the philtrum. To investigate the operative effect, we reviewed 43 patients with microform cleft lip and 102 patients with secondary cleft lip treated with muscle flap reconstruction between January 2018 and June 2020. The patients were scanned using the digital three-dimensional stereophotogrammetry face system pre- and post-operatively, and comparative analysis of three-dimensional (3D) images was used to highlight variations of the philtrum. Visual analog scales were used to assess surgical outcomes. More than 6 months after the surgery, comparative 3D images of 37 patients (86.04%) with microform cleft lip and 86 patients (84.31%) with secondary cleft lip showed visible improvement in the prominence of the affected column. In addition, visual analog scale scores showed that 38 microform cleft lip patients (88.37%) and 89 secondary cleft lip patients (87.25%) had a good appearance. The postoperative prominence of the philtral column in both groups improved significantly compared to before surgery (P < 0.001 and P < 0.001, respectively). There was no significant difference in scores for philtrum prominence pre- and post-operatively between the 2 groups (P > 0.05). Muscle flap reconstruction is an effective means to create the 3D configuration of the philtrum. The biomechanical properties of muscles play a vital role in the morphological maintenance of the philtrum.

Multiple Structural Microform Defects Suggest Role of Modifier Genes.

ABSTRACT: One of the biggest challenges in clinical genetics is establishing associations between specific germline mutations and the resulting spectrum of phenotypes. The careful characterization of clinical presentations continues to be a tool for establishing these genotype phenotype correlations. The authors intend, by presenting a case study, proposing that the concomitant occurrence of a combinations of mild structural anomalies in the same individual may be due to changes in genes that can be linked by related pathways. A new born with cleft lip and palate was referred at the Cleft Lip and Palate Center. The anamnese was performed and collected data of familiar history, parental consanguinity, and information about pregnancy period. The careful characterization of clinical presentations and the genetic pathways was studied. It is possible that there is no single mutation that can be clearly identified as the etiology of the combination of the defects displayed in the present case.

Long-Term Outcomes of the Minimal Skin Incision Technique for Correcting Severe Microform and Minor-Form Cleft Lip With Philtrum Reconstruction Through the Intraoral Incision.

BACKGROUND: Because the traditional technique is known to cause visible scarring, it is challenging to yield optimal outcomes while treating a severe type of microform and minor-form cleft lip. The authors present a new refined technique with minimal skin incision and philtrum formation through an intraoral incision. METHODS: The surgical technique involves single Z-plasty or double or triple unilimb Z-plasty to restore an elevated cupid's bow peak and overlapping of an orbicularis oris muscle flap to create the philtrum through an intraoral incision. Cleft lip nasal deformity was corrected with reverse-U incision and V-Y plasty. RESULTS: Eighteen patients were operated between September 2008 and June 2017. Patient age at the time of surgery ranged from 3 to 12 months. The duration of follow-up ranged from 12 months to 7 years (mean, 36 months). The elevated cupid's bow was corrected by performing single Z-plasty in 6 patients, double unilimb Z-plasty in 7 patients, and triple unilimb Z-plasty in 5 patients. In all cases, the notch or elevated cupid's bow was corrected, the surgical scar was minimal, and philtrum reconstruction was satisfactory. Minor scar revision was performed in 4 patients. Cleft lip nasal deformity was corrected in fifteen patients. CONCLUSIONS: The technique adopted here causes minimal scarring, facilitates the formation of an anatomical philtrum, preserves the continuity and function of the muscle, and presents sufficient elevation of the philtral column.

Tailored Microform Cleft Lip Repair: Personalizing Small Incisions, Orbicularis Reconstruction, and Rhinoplasty.

BACKGROUND: In the last decade, many surgeons have reported their perspectives on microform cleft lip repair, including techniques for incision placement and size, philtral reconstruction, and nasal base reconstruction. This interest demonstrates continued controversy in the repair of microform cleft lip. METHODS: This is a retrospective cohort of patients from 2010 to 2016. The authors included patients with microform cleft lip repaired by our described technique who had both preoperative photographs, as well as photographs taken at >1-year follow-up. Patient outcomes were assessed through anthropometric measurements and also subjectively by 3 senior residents of plastic surgery. RESULTS: The inclusion criteria yielded 36 microform cleft lip patients. Most patients were satisfied with their results. Regarding subjective assessment, the scar appearance and symmetry was fairly good. Objective measurements indicated excellent symmetry, with the cleft side achieving 92.58% of the height and measurements of the non-cleft side. CONCLUSIONS: Our method of combining labial muscle reconstruction through a personalized, small incision effectively corrects microform cleft lip deformity with minimal scar burden.

Effects of birch encroachment, water table and vegetation on methane emissions from peatland microforms in a rewetted bog.

This study investigated the influence of vegetation and microforms on methane (CH4) balances of a rewetted bog in north-west Germany. The two study sites are in close proximity on the same former peat extraction area, one dominated by Sphagnum-mosses and the other one by a dense Betula pubescens stand with a high Eriophorum vaginatum cover. The contribution of microforms (hummocks/hollows) to CH4 emissions and the effect of Betula encroachment has been studied. Transparent and opaque chambers were used to measure CH4 fluxes every 3-4 weeks during daytime for one year. For the estimation of annual balances, three methods were compared and the method using water level and soil temperature as explanatory variables was selected. Fluxes were scaled to the site level. The annual emissions per site are and 7.1 ± 1.5 g CH4-C m-2 year-1 at the treed site and 36.1 ± 3.5 g CH4-C m-2 year-1 at the open site, mainly controlled by higher water levels. Highest annual emissions originated from hollows at the open site, but in the vegetation period, hummock emissions tend to be higher. At the tree site, emission differences between the microforms were less pronounced. There were no differences between fluxes from transparent and opaque chambers.

Infrared color photography: selective demonstration of bacteria.

A microscopic procedure employs infrared color photography to enable visualization of unstained microorganisms in natural habitats. The procedure can be used for either living or dead microorganisms; it enables visualizaion of microbial cells embedded within component materials of the habitat.

The crisis facing printed medical literature. Acid paper.

Medicine strives to preserve the achievements of the past for the benefit of future clinicians and scientists. However, the paper on which medical journals are printed is steadily and irreversibly decaying. Since the late 1800s, most medical journals have been published on paper prepared with acids. In recent years, publishers, authors, and archivists have become aware of the destructive effects of acid decay on medical journals. Though the cause of deterioration is well understood, the choice of a remedy is still controversial. Remedies include acid-free paper, computerization, deacidification, and microfilm. These techniques are reviewed for their reliability, comprehensiveness, and cost-effectiveness. Microfilm is recommended above other techniques as the most immediately promising solution. The authors propose that publishers be required by law to submit archival quality microfilm as a condition for copyright protection.

Assessing nest-building behavior of mice using a 3D depth camera.

We developed a novel method to evaluate the nest-building behavior of mice using an inexpensive depth camera. The depth camera clearly captured nest-building behavior. Using three-dimensional information from the depth camera, we obtained objective features for assessing nest-building behavior, including "volume," "radius," and "mean height". The "volume" represents the change in volume of the nesting material, a pressed cotton square that a mouse shreds and untangles in order to build its nest. During the nest-building process, the total volume of cotton fragments is increased. The "radius" refers to the radius of the circle enclosing the fragments of cotton. It describes the extent of nesting material dispersion. The "radius" averaged approximately 60mm when a nest was built. The "mean height" represents the change in the mean height of objects. If the nest walls were high, the "mean height" was also high. These features provided us with useful information for assessment of nest-building behavior, similar to conventional methods for the assessment of nest building. However, using the novel method, we found that JF1 mice built nests with higher walls than B6 mice, and B6 mice built nests faster than JF1 mice. Thus, our novel method can evaluate the differences in nest-building behavior that cannot be detected or quantified by conventional methods. In future studies, we will evaluate nest-building behaviors of genetically modified, as well as several inbred, strains of mice, with several nesting materials.

Reoperation without medical records: avoidable?

Coronary bypass graft reoperations are performed at increased risk if prior operative records are unavailable. A durable record of the operation, carried by the patient, may offer the most rapid access to this information.

Use of an automated microfilm system in the surgical pathology laboratory.

The use of the Kodak "Oracle System" in a pathology laboratory is described. After five years experience, the system can be described as very reliable and extremely useful for consolidating, condensing, searching, and maintaining files in a busy surgical pathology laboratory.

Requests for retrieval of laboratory results from archive.

The design of laboratory archives depends to a large extent on frequency and type of access required. This article reports a study in which all requests for laboratory archival data were tabulated carefully. Such requests are infrequent and usually involve specific test results. An inexpensive, efficient, and convenient method of storing such data is described, employing a laboratory computer and magnetic tape-to-microfiche software. The efficiency of this system permits indefinite storage which may be desirable in view of the medico-legal climate.

Report filing in histopathology.

An assessment of alternative methods of filing histopathology report forms in alphabetical order showed that orthodox card index filing is satisfactory up to about 100000 reports but, because of the need for long-term retrieval, when the reports filed exceed this number they should be copied on jacketed microfilm and a new card index file begun.

Microfiche as a medium for the long-term storage of laboratory computer records.

The chemical pathology requests on 180 000 patients a year are stored on microfiche, occupying 72 mm of shelf space. They are produced by a sequence of three computer programs which remove data from disc on to magnetic tape using the laboratory's Digital Equipment Corporation PDP 11/34 minicomputer. Processing on to microfiche is performed by a bureau. The magnetic tape is available for retrospective research and management studies in one-month periods.

Microfilm storage of fetal monitoring records: a practical solution.

Microfilming of fetal monitoring records has, at our institution, been found to be a practical method for storage of recording papers from fetal monitoring. This system permits a reduction of the records by a factor of 20:1 and up to 7.64 hours of fetal monitroing records will fit into a 4 x 6 inch film jacket. This microfilm record can easily be placed into a patient's chart and can thus easily be retrieved.

A small computer at the radiology reception desk.

An intelligent terminal has been used at a radiology reception desk to maintain a master patient index and to assist documentation. It also yields valuable management information.

Microfiche data reduction for the EEG laboratory.

A convenient, low cost microfiche system for the random access, storage and retrieval of EEG data is described. Some of the more important advantages of microfilm in an EEG laboratory are: enormous data reductions; reduced operating costs; simplified records handling; improved communications between electroencephalographers; and access to an expanding number of inexpensive publications and reference materials.