Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate.

BACKGROUND: Nasoalveolar molding (NAM) is a presurgical orthopedic technique used in the management of cleft lip and palate deformities. Despite the widespread use of NAM therapy, there is a need for further investigation to assess its specific effects on arch dimensions and malocclusion characteristics. AIM: To evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). DESIGN: Patients in primary dentition were referred to the Institutional Department of Orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7 ± 0.7 years) and 12 patients with BCLP (mean age 4.8 ± 0.7 years). Sixteen patients with UCLP (mean age 4.9 ± 0.9 years) and five patients with BCLP (mean age 5.4 ± 1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. RESULTS: Intercanine and intermolar widths showed statistically significant differences according to the cleft type (p < .01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (p > .05). The prevalence of anterior crossbite was 12.1% in the NAM group and 23.8% in the non-NAM group. CONCLUSION: NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.

A Novel Surgical Method of Reconstruction for Proboscis Lateralis: A Case Report and Review of the Literature.

Proboscis lateralis (PL) is a rare congenital craniofacial anomaly and it is represented by rudimentary, tube-like nasal structure measuring 2-3 centimetre (cm) length and generally attaches to medial canthal region. A 22-month-old male patient was referred to our clinic with a PL hanging from the right medial canthus and a coloboma on the medial third of the right lower eyelid. Physical examination revealed that the PL was 4 cm long and 1.5 cm in diameter. There was a blind cavity with dimple at its distal segment. The right side of the nose and the nasal airway was aplastic. Before surgical correction, neuroradiological evaluation should be performed to obtain the characteristics and relationship of the lesion with adjacent structures and associated anomalies Many reconstructive options have been described in the literature, however, these options are insufficient to obtain natural contour and define alar crease, especially. We described the laterally-based skin flap from the medial wall of the left heminose and adapted to the lateral edge of the de-epithelialized skin of PL for defining supra-alar crease.

Photobiomodulation combined with adipose-derived stem cells encapsulated in methacrylated gelatin hydrogels enhances in vivo bone regeneration.

Reconstruction of bone defects is still a significant challenge. The aim of this study was to evaluate the effect of application of photobiomodulation (PBM) to enhance in vivo bone regeneration and osteogenic differentiation potential of adipose-derived stem cells (ADSCs) encapsulated in methacrylated gelatin (GEL-MA) hydrogels. Thirty-six Sprague-Dawley rats were randomly separated into 3 experimental groups (n = 12 each). The groups were control/blank defect (I), GEL-MA hydrogel (II), and ADSC-loaded GEL-MA (GEL-MA+ADSC) hydrogel (III). Biparietal critical sized bone defects (6 mm in size) are created in each animal. Half of the animals from each group (n = 6 each) were randomly selected for PBM application using polychromatic light in the near infrared region, 600-1200 nm. PBM was administered from 10 cm distance cranially in 48 h interval. The calvaria were harvested at the 20th week, and macroscopic, microtomographic, and histologic evaluation were performed for further analysis. Microtomographic evaluation demonstrated the highest result for mineralized matrix formation (MMF) in group III. PBM receiving samples of group III showed mean MMF of 79.93±3.41%, whereas the non-PBM receiving samples revealed mean MMF of 60.62±6.34 % (p=0.002). In terms of histologic evaluation of bone defect repair, the higher scores were obtained in the groups II and III when compared to the control group (2.0 for both PBM receiving and non-receiving specimens; p<0.001). ADSC-loaded microwave-induced GEL-MA hydrogels and periodic application of photobiomodulation with polychromatic light appear to have beneficial effect on bone regeneration and can stimulate ADSCs for osteogenic differentiation.

Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate.

BACKGROUND: Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES). METHODS: This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined. RESULTS: The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976. CONCLUSION: The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.

ALX-Related Frontonasal Dysplasias: Clinical Characteristics and Surgical Management.

AIM: The term frontonasal dysplasia (FND) represents a spectrum of anomalies and its genetics have not been well defined. Recently, the critical role of the aristaless-like homeobox (ALX) gene family on the craniofacial development has been discovered. In the present study, we aimed to propose a systematic surgical treatment plan for the ALX-related FNDs according to the genotypic classification as well as demonstrating their clinical characteristics to help surgeons diagnose the underlying pathology accurately. DESIGN: Single-institution retrospective. SETTING: Tertiary health care. PATIENTS AND METHODS: Eighty-nine FND cases were evaluated. Eight of them had ALX1-related FND3, 3 had ALX3-related FND1, and 2 had ALX4-related FND2. Phenotype characteristics of ALX-related FNDs were evaluated, and relevant surgical interventions were assessed. RESULTS: The ALX1-related FND3 phenotype is striking due to the involvement of the eyes in addition to the presence of hypertelorism, facial clefts, and nasal deformities. A widened philtrum and prominent philtral columns are remarkable features of the ALX3-related FND1, whereas the ALX4-related FND2 has more severe deformities: severe hypertelorism, brachycephaly, large parietal bone defects, broad nasal dorsum, and alopecia. Facial bipartition, box osteotomies, eyelid coloboma repair, cleft lip and palate repair, nasal reconstruction, and fronto-orbital advancement can be performed in ALX-related FNDs based on the characteristics of each subtype. CONCLUSIONS: This genetic classification system will help surgeon diagnose patients with FND with unique features and draw a roadmap for their treatment with a better surgical perspective.

A Challenging Period After Repair: Etiology and Follow-Up Rates of the Patients With Cleft Lip and Palate in Intensive Care Unit.

ABSTRACT: The perioperative period is quite challenging because of the featured anatomical and clinical properties of the babies with cleft lip and palate (CLP). Therefore follow-up in the intensive care unit (ICU) is a crucial parameter for managing these patients. Although various studies in cleft literature, limited studies have analyzed the ICU admission rate and its etiology in the cleft population. At this point, the present study aims to reveal the etiology and rate of ICU admission of babies with an orofacial cleft to contribute to taking preventive precautions.The rate of primary CLP patients was 69.5% (937 of 1348 patients). Intensive care unit admission rate of primary CLP patients was 6.2% (n = 58). The expected and unexpected ICU admission rate was 4.8% and 1.4%, respectively. Of the patients admitted to the ICU, 53.4% (n = 31) were boys and 46.6% (n = 27) were girls. There was no statistically significant association between gender and ICU admission (P = 0.896). However, the association between cleft type and ICU follow-up was statistically significant (P < 0.001).The findings of the present study reveal the high ICU admission rate of cleft patients within all patients admitted to ICU. Due to many unique statuses of cleft babies, attentive assessment in the preoperative period and determining the postoperative need for ICU follow-up would contribute to preventing postoperative complications.

The Impact of Middle Eastern Crisis on Cleft Care: Evaluation of Demographic and Perioperative Data in Syrian Refugees With Cleft Lip and Palate.

The cleft lip and palate (CL/P) define a heterogeneous group of congenital deformities, which are morphologically highly diverse, with a complex and multifactorial etiology. Affected children may experience social problems due to negative effects on speech, hearing, facial appearance, as well as negative psychological effects on the parents. In 2011, after the civil war began in Syria, a great wave of immigration began to Turkey and other neighboring countries. Refugees may not be able to receive optimal health care because of cultural differences, socioeconomic status, language problems, and psychosocial problems. To increase awareness about this issue, the authors investigated the demographic, perioperative, and post-operative data of Syrian refugee patients with CL/P who were admitted to our cleft center between January 2016 and May 2019. Sixty-eight refugees with CL/P were detected as the result of the screening. Unlike the protocol the authors follow in our center, cleft lip repair was performed at an average of 7.6 months and cleft palate repair was performed at an average of 28.7 months of age. The rate of fistula was found 26.2%.The civil war in Syria has caused the repair of the patients with cleft lip and palate at a later age, hampered the follow-up and treatment, and caused more complications. Considering the demographic, social, economic and cultural characteristics of the patients, it was demonstrated that the necessary health precautions and infrastructure should be provided on the pillar of plastic surgery.

Assessment of Nutrition and Feeding Interventions in Turkish Infants with Cleft Lip and/or Palate.

PURPOSE: The present study aimed to highlight the feeding challenges of infants with cleft lip and/or palate (CLP) that caregivers encounter and analyze the alternative interventions they perform based on their experiences in the preoperative period. DESIGN AND METHODS: Parents of 200 infants with CLP were asked to complete our questionnaire. The prenatal feeding preparations, preoperative processes, and feeding challenges and modifications to overcome these difficulties were evaluated. RESULTS: One-third of the caregivers stated that they had received feeding education prenatally. Sixty-five percent of the parents stated that they were not successful in breastfeeding. Infants with isolated cleft lip had minor feeding difficulties, whereas the ones with cleft palate had some major challenges such as aspiration, choking, and inadequate growth. Parents also reported that 59.5% of the infants with cleft had stayed in the intensive care units following birth. Moreover, 42% of the infants were initially fed by nasogastric or orogastric tube. Out of the 166 infants with cleft palate, 31.9% used palatal obturators. CONCLUSIONS: We have reviewed the various feeding difficulties of the infants with clefts and highlighted the results of the interventions performed to overcome these difficulties for better nutrition and growth. PRACTICE IMPLICATIONS: In the light of our findings, further studies should be conducted and additional educational programs should be implemented for both healthcare providers and parents to increase families' awareness regarding cleft feeding, prevent unnecessary and improper feeding interventions in infants with clefts, and alleviate the burden of feeding difficulties for both parents and infants.

Photobiomodulation with polychromatic light increases zone 4 survival of transverse rectus abdominis musculocutaneous flap.

OBJECTIVE: The aim of this study was to evaluate the effect of relatively novel approach of application of polychromatic light waves on flap survival of experimental musculocutaneous flap model and to investigate efficacy of this modality as a delay procedure to increase vascularization of zone 4 of transverse rectus abdominis musculocutaneous (TRAM) flap. METHODS: Twenty-one Wistar rats were randomized and divided into 3 experimental groups (n = 7 each). In group 1 (control group), after being raised, the TRAM flap was sutured back to its bed without any further intervention. In group 2 (delay group), photobiomodulation (PBM) was applied for 7 days as a delay procedure, before elevation of the flap. In group 3 (PBM group), the TRAM flap was elevated, and PBM was administered immediately after the flap was sutured back to its bed for therapeutic purpose. PBM was applied in 48 hours interval from 10 cm. distance to the whole abdominal wall both in groups 2 and 3 for one week. After 7 days of postoperative follow-up, as the demarcation of necrosis of the skin paddle was obvious, skin flap survival was further evaluated by macroscopic, histological and microangiographic analysis. RESULTS: The mean percentage of skin flap necrosis was 56.17 ± 23.68 for group 1, 30.92 ± 17.46 for group 2 and 22.73 ± 12.98 for group 3 PBM receiving groups 2 and 3 revealed less necrosis when compared to control group and this difference was statistically significant. Vascularization in zone 4 of PBM applied groups 2 and 3 was higher compared to group 1 (P = 0.001). Acute inflammation in zone 4 of group 1 was significantly higher compared to groups 2 and 3 (P = 0.025). Similarly, evaluation of zone 1 of the flaps reveled more inflammation and less vascularization among the samples of the control group (P = 0.006 and P = 0.007, respectively). Comparison of PBM receiving two groups did not demonstrate further difference in means of vascularization and inflammation density (P = 0.259). CONCLUSION: Application of PBM in polychromatic fashion enhances skin flap survival in experimental TRAM flap model both on preoperative basis as a delay procedure or as a therapeutic approach. Lasers Surg. 51:538-549, 2019. © 2019 Wiley Periodicals, Inc.

Assessment of Neurologic Disorders and Rare Intracranial Anomalies Associated With Cleft Lip and Palate.

Accompanying neurologic disorders directly affect psychosocial development of cleft lip and/or cleft palate (CLP) patients and make it difficult for their family to look after them properly. The aim of this study was to investigate the diversity and the incidence of additional neurologic malformations in children with CLP and to evaluate their effects on cleft care. All patients who applied to our Cleft and Craniofacial Center between July 2014 and July 2017 were included in the study. Demographic and perioperative data such as gender, cleft type, syndromic status of the patient, associated neurologic anomalies, timing and duration of operation, hospitalization period, and follow-up period in the intensive care unit are all recorded. All patients received an interdisciplinary evaluation including pediatric neurology specialists in terms of mental and/or motor developmental delay, epilepsy, and other neurologic disorders. After detailed neurologic examination, 83 (3.8%) out of 2190 were reported as having a neurologic defect. The most leading neurologic disorder was found to be mental-motor retardation in 57 children followed by epileptiform disorders detected in 36 children. In 22 patients, rare intracranial pathologies were detected on magnetic resonance imaging. According to our results, having a neurologic pathology increases the need for intensive care unit stay by 5 times in these patients. There was statistically significant relationship between hospitalization period, age of cleft surgery, and neurologic pathologies in these patients. Neurologic disorders could complicate cleft care, cause delays in the planned surgery schedule, and increase perioperative and postoperative morbidity.

Cleft Palate Repair Using Single Flap Palatoplasty in Patient With Associated Palatal Hemangioma.

Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors' patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3 cm. To reduce the size of the vascular lesion 7 mg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing.

Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty.

Submucous cleft palate (SMCP) is a relatively rare variant of the common pathology of cleft palate with specific anatomic and clinical features. Even though there are many surgical options defined previously to correct the SMCP, correction of the velopharyngeal insufficiency and obtaining ideal speech results remains as a challenge. The aim of this article was to compare the speech benefits of Furlow double opposing Z plasty and posterior pharyngeal flap operation combined with intravelar veloplasty for the correction of SMCP using objective assessment tools. This study reviewed 29 patients who underwent either superiorly based posterior pharyngeal flap combined with intravelar veloplasty or Furlow palatoplasty for submucous cleft palate repair between years 2005 and 2011. The mean standard deviation age at palate repair was 123.6 ±â€Š65.8 months and the mean follow-up period was 31.2 ±â€Š15.9 months. The postoperative results demonstrated that in both groups significantly correction has been achieved in means of velopharygeal closure (P values for Furlow and pharyngeal flap groups are 0.012 and 0.001 respectively). The correction of the nasalance scores obtained depending on the surgical procedure for /sa/ and /ka/ syllables demonstrated significantly more benefit with pharyngeal flap combined with intravelar veloplasty than Furlow palatoplasty (P = 0.026 for each). In the treatment of submucous clefts, both Furlow palatoplasty and pharyngeal flap procedure combined with intravelar veloplasty appear to be effective whereas for the patients having significant signs of hypernasality, contribution of pharyngeal flap may be taken into consideration.

Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age.

INTRODUCTION: The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS: Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS: No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS: NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.

Submucous cleft palate: from diagnosis to management

Background/aim: The aim of this study was to investigate submucous cleft palate (SMCP) patients in order to document the age of diagnosis, cause of referral, symptoms and palate findings, objective evaluation of nasalance and velopharyngeal dysfunction (VPD), and intervention type. Material and methods: The archive of Hacettepe University Cleft Lip and Palate, Craniomaxillofacial Anomalies Research, Treatment, and Application Center was reviewed retrospectively, and 166 patients diagnosed with SMCP were documented. Results: The mean age of the patients at the time of initial referral was 10 years and 3 months ± 8 years and 5 months with the youngest being 1 month and the oldest 44 years old. The primary complaint of 127 (76.5%) patients was speech disorder. Seventy-nine patients underwent surgery, and the mean age was determined as 10 years ± 6 years and 8 months. Conclusion: The diagnosis of SMCP continues to be rather late, being delayed until a prominent speech disorder is present. Studies for the awareness of health professionals are of great importance for the early diagnosis and intervention of SMCP in order to prevent adverse effects.

A Biomimetic Alternative to Synthetic Hydroxyapatite: "Boron-Containing Bone-Like Hydroxyapatite" Precipitated From Simulated Body Fluid.

BACKGROUND: Biological hydroxyapatite (HA), has several mechanical and physical advantages over the commercially available synthetic apatite (CAP-HA). The aim of this in vivo study was to investigate the effect of osteoinductive "bone-like hydroxyapatite" obtained from simulated body fluid (SBF) combined with osteoinductive "boron" (B) on bone healing. MATERIALS: Bone like nanohydroxyapatite (SBF-HA) was precipitated from 10× simulated body fluid (10×SBF). Thirty Sprague-Dawley rats were randomly divided into 5 experimental groups (n = 6 each). The groups were involving blank defect, chitosan, SBF-HA, SBF-HA/B, and CAP-HA. Two biparietal round critical sized bone defect was created using a dental burr. The rats were sacrificed respectively at the end of second and fourth months after surgery and their calvarium were harvested for further macroscopic, microtomographic, and histologic evaluation. RESULTS: The SBF-HA/B group demonstrated the highest mineralized matrix formation rates (30.69 ± 3.73 for the second month, 62.68 ± 7.03 for the fourth month) and was significantly higher than SBF-HA and the CAP-HA groups. The SBF-HA/B group demonstrated the highest mineralized matrix formation rates (30.69 ± 3.73 for the second month, 62.68 ± 7.03 for the fourth month) and was significantly higher than SBF-HA and the CAP-HA groups. In means of bone defect repair histologically, the highest result was observed in the SBF-HA/B group (P < 0.001). CONCLUSIONS: The "bone-like hydroxapatite" obtained from simulated body fluid is worth attention when both its beneficial effects on bone healing and its biological behavior is taken in consideration for further bone tissue engineering studies. It appears to be a potential alternative to the commercially available hydroxyapatite samples.

Modified Superior-Based Pharyngeal Flap Is Effective in Treatment of Velopharyngeal Insufficiency Regardless of the Preoperative Closure Pattern.

Velopharyngeal insufficiency (VPI) is certainly one of the most important problems confronted after cleft palate repairs. In this study, it was aimed to evaluate the preoperative and postoperative speaking results of patients who underwent modified superior-based pharyngeal flap. Sixty-six children who underwent modified superiorly based pharyngeal flap for treatment of VPI between 2005 and 2013 were retrospectively reviewed. The study population was evaluated in 2 distinctive groups depending on their preoperative velopharyngeal closure pattern as: coronal closure pattern or noncoronal closure patterns (ie, circular, sagittal with or without the presence of a Passavant ridge). The speech outcome of the patients was evaluated using the objective assessment tools of nasopharyngoscopy and nasometer. Coronal closure pattern was determined in 24 patients (36.4%) and noncoronal closure pattern in 42 patients (63.6%). The mean follow-up period was 14.67 ±â€Š3.90 and 13.74 ±â€Š3.53 months in the coronal and noncoronal groups, respectively. The results demonstrated that the postoperative nasalance scores of all syllables except (m) and (n) were found to be significantly lower compared to those of the preoperative period (P < 0.001). However, no significant difference between the preoperative and postoperative results was observed in means of closure pattern. The surgical approach of modified superior-based pharyngeal flap for treatment of VPI appears to be effective regardless of the preoperatively determined closure pattern.

Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.

Poly(L-Lactide)/Poly(ε-Caprolactone) and Collagen/ß-Tricalcium Phosphate Scaffolds for the Treatment of Critical-Sized Rat Alveolar Defects: A Microtomographic, Molecular-Biological, and Histological Study.

OBJECTIVE: To determine the efficacy of a newly developed scaffold (col/ß-TCP) in a preclinical rat model as compared with the gold standard treatment (autograft) and control scaffolds (PLLA/PCL). DESIGN: Fifty-six Sprague-Dawley rats were randomized into four experimental groups, and critical-sized alveolar defects (7 × 4 × 3 mm) were created in each animal. Group A was the blank defect group, group B received autograft, group C received col/ß-TCP scaffolds, and group D received PLLA/PCL blend scaffolds to fill the bone defects. New bone formation was assessed radiomorphometrically, histomorphometrically, and molecular-biologically at 1 and 4 months following surgery. RESULTS: Radiomorphometrically, the best new bone volume rate at 1 month (43.7%) and 4 months (45.4%) was observed in the autograft group, and the difference was significantly higher than in the other three groups (P < .005, P < .001, P < .001 for 1 month and P = .004, P < .001, P < .001 for 4 months). Even though the new bone volume rate in the col/ß-TCP group (21.5%) was higher than that of the PLLA/PCL group (18.2%), the difference was not significant (P = .08). Molecular-genetic analysis revealed significantly higher BSP and ALP gene expression levels in the autograft and col/ß-TCP groups than in the blank defect group (P = .002 and P = .004). CONCLUSION: The engineered tissue scaffolds described herein have great potential as an alternative treatment option when cost, donor region morbidity, and duration of hospitalization are considered.

Effect of a combined oral contraceptive on patency of arterial anastomosis in a female rat model.

BACKGROUND: Oral contraceptives, which may lead to thrombotic events, are widely used drugs by women in reproductive age, some of whom might need emergent or elective microsurgical intervention. This study was planned to investigate the effects of combined oral contraceptives (COC) on arterial anastomosis patency in female rat model. METHODS: A third generation COC (ethinyl estradiol and desogestrel) was used in this study. A total of 50 female Wistar albino rats were included. The rats were divided into two groups. Experimental group received 0.03 mg ethinyl estradiol/0.15 mg desogestrel with gastric catheter for 20 days before the surgery. Afterward, the femoral arteries of all rats were divided and anastomosed. The patency of the anastomoses were assessed surgically (at 15 min, 7th day) and radiologically with Doppler ultrasonography (at 3rd and 7th days). The samples were examined using light microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). RESULTS: The early patency assessed in the 15th min showed arterial flow in all rats. But at the 7th day 68% of the anastomosis were patent in the COC group while 100% of the anastomosis were patent in the control group as demonstrated surgically and radiologically (P = 0.004). Microscopic examination showed an increase in cytoplasmic organelles and activation of endothelial cells in all rats in the experimental group that received COCs. CONCLUSION: The present study demonstrated the negative effects of the use of COCs on anastomosis patency in rats.

Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients.

INTRODUCTION: The craniofacial morphology of subjects with cleft lip and palate differs from that of subjects without clefts. Subjects with bilateral cleft lip and palate tend to have maxillary retrognathism, a smaller mandible with an obtuse gonial angle, greater anterior upper and lower facial heights, and retroclined maxillary incisors. The purposes of this research were to compare the skeletal and upper-airway features of subjects with bilateral cleft lip and palate with the same features in control subjects without clefts and to determine the growth-related changes at different growth stages. METHODS: The sample comprised 212 subjects divided into 2 groups: 68 with bilateral cleft lip and palate, and 144 controls without clefts; each group was further divided into 4 subgroups according to growth stage using the cervical vertebral maturation stage method. The subgroups were defined as early childhood (stage 1), prepubertal (stage 2), pubertal (stage 3), and postpubertal (stage 4). The cephalometric variables were evaluated with 2-way analysis of variance and the Bonferroni test. RESULTS: Maxillary position showed no significant differences between the male groups. The maxilla was more prognathic at stage 2 and became more retrognathic at stages 3 and 4 in the females. The mandible was more retrusive in the bilateral cleft lip and palate subjects at stage 1 in males and at stages 3 and 4 in females. ANB was larger at stages 1 and 2, and it became similar to the controls at stages 3 and 4 in male and female bilateral cleft lip and palate subjects. Vertical growth was seen in the bilateral cleft lip and palate subjects regardless of sex, and no change was observed with age. Posterior airway space was narrower in all stages (except for stage 1 in females). Middle airway space was wider after stage 1 in the male and female bilateral cleft lip and palate subjects. Inferior airway space was narrower in the male bilateral cleft lip and palate patients at the early childhood and pubertal stages. CONCLUSIONS: Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the bilateral cleft lip and palate subjects were identified when compared with the control subjects without clefts.