Changes in maxillofacial morphology and velopharyngeal function with two-stage maxillary distraction-mandibular setback surgery in patients with cleft lip and palate.

Maxillary distraction is increasingly used for the correction of severe maxillary retrusion in patients with cleft lip and palate. However, control of the maxillary movement is difficult, and the need to wear visible distractors for a long period of time causes psychosocial problems. A two-stage surgical approach consisting of maxillary distraction and mandibular setback was developed to overcome these problems. In this study, changes in maxillofacial morphology and velopharyngeal function were examined in 22 patients with cleft lip and palate who underwent this two-stage approach. Lateral cephalograms taken just before the first surgery, immediately after the second surgery, and at completion of the active post-surgical orthodontic treatment were used to examine maxillofacial morphology. Velopharyngeal function was evaluated by speech therapists using a 4-point scale for hypernasality. The average forward movement of the maxilla with surgery at point A was 7.5mm, and the average mandibular setback at pogonion was 8.6mm. The average relapse rate during post-surgical orthodontic treatment was 25.2% for the maxilla and 11.2% for the mandible. After treatment, all patients had positive overjet, and skeletal relapse was covered by tooth movement during postoperative orthodontics. Velopharyngeal function was not changed by surgery. This method can shorten the period during which the distractors have to be worn and reduce the patient burden.

Cyclooxygenase-2 activity is essential for the osseointegration of dental implants.

The aim of this study was to examine the effect of cyclooxygenase (COX)-2 on bone response after the placement of implants in the femurs of mice. titanium implants 1.0mm in diameter were placed into the middle of the femurs of 9-week-old male COX-2 wild-type (COX-2(+/+)) and knockout (COX-2(-/-)) mice. For RNA analysis, the mice were killed 0, 1, 2, 4, 7 and 56 days after implantation. RNA was extracted from the bone surrounding the implants. For histological analysis, the mice were killed 4 and 8 weeks after treatment, and undecalcified sections were prepared. Contact microradiography was performed, and the sections were stained with 1% toluidine blue for histological examination. Histomorphometric measurements were obtained with a computer-based image analyser to quantify bone newly formed around the implant and the rate of implant-bone contact. Expression of COX-2 and osteocalcin mRNA was induced in bone surrounding implants in COX-2(+/+) mice, but not in COX-2(-/-) mice. In cortical bone, the implant surface was in direct contact with newly formed bone lamellae in COX-2(+/+) mice; new bone formation was minimal in COX-2(-/-) mice. These results suggest that COX-2 plays an essential role in osseointegration and provide evidence that COX-2-selective non-steroidal anti-inflammatory drugs may interfere with osseointegration clinically.

A 2-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery in patients with cleft lip and palate.

A 2-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery was used to correct jaw deformities in 5 patients with severe maxillary retrusion secondary to cleft lip and palate. First, a Le Fort I maxillary osteotomy was performed. Immediately after maxillary distraction, the distraction device was removed. The advanced maxilla was fixed with miniplates after adjusting the length and direction of advancement, and mandibular setback surgery was performed simultaneously to obtain a normal occlusal relationship. This 2-stage procedure resulted in stable occlusion and a markedly improved facial profile.

Complications after intraoral vertical ramus osteotomy: relationship to the shape of the osteotomy line.

Intraoral vertical ramus osteotomy (IVRO) is used widely to correct mandibular prognathism. However, several disadvantages of this procedure have been reported, such as condylar luxation and bony interference at the osteotomy site. The aim of this study was to survey the incidence of complications (condylar luxation and bony interference) based on the shape of the osteotomy line. One hundred and eighty-five rami in 118 patients with jaw deformities, which were treated with IVRO, were examined retrospectively. The shape of the osteotomy line and the postoperative complications were examined on panoramic radiographs. Osteotomy lines were classified into three types: vertical, C-shaped, and oblique. Of the 185 osteotomy sites, 98 were vertical, 37 C-shaped, and 50 oblique. Condylar luxation was found in six rami (3.2%); four had undergone vertical osteotomy and two had undergone C-shaped osteotomy. Bony interference occurred in seven rami (3.8%), all with vertical type osteotomy lines. Most complications occurred in the vertical type cases and no complications were found in oblique type cases. Condylar luxation was found mainly in unilateral IVRO cases and bony interference was found in bilateral IVRO cases. These results suggest that the oblique type of osteotomy line has the advantage of avoiding complications.

Comparison of arachidonic acid metabolism between myofibroblasts and fibroblasts isolated from rat palatal mucoperiosteum.

Myofibroblasts were cultured successfully from experimental wound tissue in rat palatal mucoperiosteum. Arachidonic acid metabolizing activity in cultured myofibroblasts was compared with that in fibroblasts cultured from normal mucoperiosteum. Prostaglandins biosynthesized from [14C]arachidonic acid in cell-free homogenates of both myofibroblasts and fibroblasts were prostaglandins D2, E2 and F2 alpha, and the activity producing each prostaglandin was not significantly different between the myofibroblasts and the fibroblasts, whereas smooth muscle cells, which are histologically similar to myofibroblasts, produced mainly 6-ketoprostaglandin F1 alpha, and relatively small amounts of prostaglandin E2. The release of arachidonic acid from cells prelabeled with [14C]arachidonic acid was compared among three types of cell. The calcium ionophore A23187 strongly enhanced arachidonic acid release in all three cell types. Bradykinin, 5-hydroxytryptamine and prostaglandin F2 alpha affected the stimulation of arachidonic acid release in the fibroblasts but were less or not effective in the myofibroblasts and smooth muscle cells. In addition, prostaglandin E2 biosynthesized in response to several stimuli was measured by radioimmunoassay. The content of prostaglandin E2 correlated closely with arachidonic acid release. In this study, we showed homogeneity between the myofibroblasts and fibroblasts in prostaglandin synthesizing activity and similarity in response to various stimuli between the myofibroblasts and smooth muscle cells, from the standpoint of arachidonic acid metabolism.

Characterization of a system of mineralized-tissue formation by rat dental pulp cells in culture.

Pulp tissue was obtained from maxillary incisors of young adult male Wistar rats, minced and digested with 0.5% trypsin and 0.02% EGTA at 37 degrees C for 30 min. Dissociated cells were cultured with or without 10 nM dexamethasone using Eagle's minimal essential medium supplemented with 10% fetal bovine serum and 50 micrograms/ml ascorbic acid. Confluent cells were subcultured at 7 days and the medium further supplemented with beta-glycerophosphate (beta-GP). Dexamethasone in primary culture and/or secondary culture enhanced the formation of mineralized tissue while > 5 mM beta-GP was necessary for mineralization to occur. Biochemical analysis of the radiolabelled medium revealed that these cells produced type I, type I trimer and type III collagens. Analysis of [32PO4]-labelled medium, using DEAE-Sephacel ion-exchange chromatography and sodium dodecylsulphate-polyacrylamide gel electrophoresis, showed that these cells produced phosphophoryn-like protein. These results indicate that some of the rat dental pulp cells in culture express an odontoblast-like phenotype.

[Questionnaire about dental health in new university students].

A questionnaire about dental health was given to 6846 new students in the University of Tokyo. The results were as follows: 1. 5.3% of students had experienced periodontal diseases. The percentage of students with gingival bleeding was 20.7%. 2. Most of the students brushed their teeth 3 minutes at a time, 2 times a day. 3. 11.5% of the students had experienced orthodontic treatments. The percentage of female students was significantly higher than the percentage of male students. 4. 0.9% of the students had experienced TMJ disorders. TMJ symptoms were noted in 9.7%. 5. More than 90% of the students usually chewed on both sides of the mouth.

[Survey on oral health of university students: examination on tooth conditions using panoramic X-ray films].

As an aid in instructions oral health care to university students, tooth conditions were examined using panoramic X-ray films. The materials were taken from 129 students of the University of Tokyo. The average age was 22 years 5 months. The results were as follows: 1. Lack of tooth was frequently found to be both maxillary and mandibular third molars. It was also occasionally found to be maxillary first premolars, mandibular lateral incisors, and mandibular second premolars. The average value for lack of tooth per individual was 0.9. 2. Root canal fillings were often found in mandibular first molars, maxillary central incisors, mandibular second molars and maxillary second premolars. The average value was 1.1. 3. Metal restorations were often made in first and second molars, especially in mandibular. The average value was 6.2. 4. As for maxillary third molar axis, the majority showed normal direction. In mandible, however, the normal direction was only found in 37.7% and the others showed troublesome axes. It seemed that careful attention should be given to the mandibular third molar conditions.

Unilateral expansion of a narrow mandibular dental arch combined with bimaxillary osteotomies in a patient with hypoglossia.

A 23-year-old female with hypoglossia, who had a narrow mandibular dental arch, was treated using the gradual expansion technique. Three lower incisors were missing and the right molar occlusion showed a scissor bite. Her speech was acceptable. Gradual unilateral expansion of the mandibular alveolar bone was performed. Orthodontic tooth alignment was performed prior to surgical treatment. A tooth-borne expander was devised using a hyrax-type screw to move the inclined right alveolar bone into an upright position. Alveolar bone osteotomies were performed under general anesthesia and the expander was placed in the mandibular dental arch. After a 5-day latency period, the screw was activated for 21 days. After expansion, the width of the mandibular dental arch increased by 10mm at the first molar region and the right molars were moved to an upright position. After a consolidation period of 7 days, simultaneous two-jaw surgery that combined Le Fort I osteotomy and intraoral vertical ramus osteotomies was performed to obtain a stable occlusion. After post-surgical orthodontic and prosthodontic treatment, her occlusion improved without deterioration of her speech. The results indicate that this technique is useful for unilateral expansion of distorted mandibular alveolar process.

Changes in the awareness of oral health among new students newly enrolled at the University of Tokyo over the past 15 years.

OBJECTIVE: The aim of this study was to examine changes in awareness of oral health among Japanese university students. METHODS: Between 1990 and 2004, a total of 51,650 students newly enrolled at the University of Tokyo responded to an annual written questionnaire on oral health. RESULTS: (i) Approximately 60% of the students brushed their teeth twice a day. Female students brushed more frequently than male students. (ii) The percentage of students who brushed for 2-3 min per time decreased, while the percentage who brushed four or more minutes increased. (iii) The number of students who had learned how to brush properly increased. This trend was particularly clear-cut among male students, although the proportion of female students who had learned to brush properly remained higher than that of male students. (iv) The percentage of female students who sought treatment for malocclusion was higher than that of male students. The percentage of students who underwent orthodontic treatment increased from 11.6 to 19.7%. The percentage of female students who received orthodontic treatment was approximately twofold that of male students. (v) The percentage of students who had temporomandibular disorders was 0.7% in males and 1.5% in females. (vi) More than 40% of the students had periodontal diseases, with a higher prevalence among male students than female students. (vii) Approximately 20% of the students wanted to consult our service centre. CONCLUSIONS: The awareness of oral health among new undergraduates at the University of Tokyo has improved over the past 15 years.

Early correction of the nose in unilateral cleft lip patients using an open method: a 10-year review.

PURPOSE: To review a 10-year follow-up of cases with rhinoplasty for a cleft lip-associated nose deformity done during the preschool years. MATERIALS AND METHODS: Sixteen patients from 16 to 19 years of age were evaluated with two indices: the nasal index and the lobule portion of the columella index. RESULTS: Several years after surgery the results appeared to be reasonably satisfactory. However, as the patients approached their adolescent growth spurt at 15 years of age, undesirable features became obvious. Each patient showed a strikingly bulbous nose. The nasal index of male patients ranged from 68.8% to 82.7% (mean, 75.4%) and that of female patients ranged from 72.7% to 85.0% (mean, 79.2%). The mean value of the nasal index in the Japanese male and female is 58.5% +/- 1.5% and 59.0% +/- 1.0%, respectively. The lobule portion index of male patients ranged from 57.1% to 72.0% (mean, 65.1%) and that of female patients ranged from 62.5% to 82.0% (mean, 74.2%). The lobule portion of the columella constitutes 33% of the total columellar length on average. CONCLUSIONS: A possible cause of the undesirable deformities is use of an open surgical method. A second possible cause is mobilization and suspension of the alar cartilages. These undesirable features may occur only in Oriental noses.

Columella lengthening using a cartilage graft in the bilateral cleft lip-associated nose: choice of cartilage according to age.

PURPOSE: This article describes the technique of columellar lengthening using a cartilaginous strut in patients with a severely deformed bilateral cleft lip-associated nose. MATERIALS AND METHODS: When the upper lip is not deficient, and especially when resection of lip scar tissue is indicated, the Millard forked flap technique is recommended. Advancement of the prolabium into the columella for lengthening, combined with an Abbé flap for upper lip reconstruction, is indicated when a deficient upper lip is unable to provide adequate donor tissue. A cartilaginous strut is inserted behind the forked flap or the advanced prolabium. According to the age of the patient, septal cartilage, costal cartilage, or ear cartilage is selected. Ten patients with a severely deformed bilateral cleft lip-associated nose underwent these procedures. RESULTS: In each case, the columella was lengthened satisfactorily. In four patients, the scar became hypertrophic at the base of the columella and scar revision was performed secondarily. CONCLUSIONS: A cartilaginous strut is the key to avoiding the tendency toward retraction or thickening of the lengthened columella. It gives a slight lift to the tip, provides more definition, and improves the columellar contour.

Orthodontic treatment of a cleft palate patient with surgically assisted rapid maxillary expansion.

Some adult cleft palate patients show severe maxillary transverse contraction and posterior crossbite. This case report demonstrates successful surgical-orthodontic treatment of such a patient. Surgically assisted rapid maxillary expansion (SA-RME) was completed prior to comprehensive orthodontic treatment. The osteotomy was performed on both the buccal and lingual aspects of the posterior maxillary alveolus. A Hyrax-type maxillary-expansion appliance was used, and the screw (0.2 mm, one quarter turn) was turned two or three times per day. Comprehensive orthodontic treatment was initiated after extraction of the mandibular first premolars and four third molars. The maxillary lateral incisors were also extracted after active orthodontic treatment. The amount of expansion achieved using SA-RME was greater at the posterior than at the anterior maxilla. Midpalatal suture opening occurred. After orthodontic treatment, occlusal stability was satisfactory. This case demonstrates the effectiveness of SA-RME in adult cleft palate patients with severe posterior crossbite.

Use of cantilever iliac bone grafts for reconstruction of cleft lip-associated nasal deformities.

PURPOSE: The purpose of this study was to describe the clinical and radiographic observations on cantilever iliac bone grafts for reconstruction of cleft lip-associated nasal deformities. MATERIALS AND METHODS: Cantilever iliac bone grafts were performed on 14 patients with a severely deformed cleft lip-associated nose using the open rhinoplasty technique. An approximately 6-cm length of iliac bone was tightly inserted into a subperiosteal pocket over the nasal bones, and the nasal tip was elevated by the distal end of the graft. The clinical follow-up ranged from 7 months to 3 years. RESULTS: All patients were judged to have satisfactory results. The grafted bone decreased slightly in size during the first 2 to 3 months, and irregularities in contour became rounded. During the same period, bony union with the underlying nasal bones was observed in all cases. After about 6 months, further changes did not occur in the grafts. CONCLUSION: This type of bone graft can be used for additional structural support and to achieve the desired nasal projection and profile. Augmenting the nasal bridge creates the illusion of a narrower nose. The key to success of the operation seems to be the proper fixation of the grafted bone to the underlying nasal bones.

Growth changes and orthodontic treatment in a patient with condylolysis.

A patient with acquired bilateral degeneration of the mandibular condyles was treated orthodontically. The flattening of condyles and the shortening of the ramus began at adolescence. The facial profile changed to a convex type, with a marked mandibular retrognathia and severe Class II malocclusion. The cause seems to be due to a condylolysis of the mandible.

Large myxofibroma of the mandible treated with segmental mandibular resection and vascularized fibular graft.

This report summarizes a case of large myxofibroma of the mandible. On the basis of the clinical appearance, radiographic findings, and biopsy specimen, the lesion was diagnosed as a myxofibroma. Segmental mandibular resection and immediate reconstruction by vascularized fibular graft were performed. At the 18-month follow-up there was no evidence of recurrence of the tumor, and good functional and aesthetic results were maintained.

Ellis-van Creveld syndrome: craniofacial morphology and multidisciplinary treatment.

OBJECTIVE: The craniofacial morphology and multidisciplinary treatment of a patient with Ellis-van Creveld Syndrome are presented. PATIENT: The patient presented is female. Her treatment began at the age of 10 years 6 months. She exhibited small stature with acromelic shortening of the extremities, postaxial syndactyly, and dysplastic nails. In the oral region, hyperplastic frena, absent anterior teeth, and small barrel-shaped teeth were noted. SETTING AND INTERVENTION: The patient was treated at the University Hospital, Faculty of Dentistry, of the Tokyo Medical and Dental University. The treatment was divided into three stages: growth observation during which the patient wore acrylic plates with artificial anterior teeth; surgical-orthodontic treatment with sagittal split ramus osteotomy; and prosthodontic treatment with removable partial dentures. MAIN OUTCOME MEASURES: Cephalometric analyses were performed to evaluate the changes in craniofacial morphology with growth during treatment. RESULTS: Characteristic craniofacial morphology included a small posterior cranial base, small maxilla, and a large mandible with an increased gonial angle. Maxillo-mandibular relation was skeletal class III, and skeletal open bite was found. The skeletal class III relationship was progressive with growth. The patient was satisfied by the results of the multidisciplinary treatment. CONCLUSION: The craniofacial morphology of the patient demonstrated disturbed growth of the cartilage bones. An acceptable result was obtained through combined surgical-orthodontic-prosthodontic treatment.

Modification of the Abbé flap for reconstruction of the vermilion tubercle and Cupid's bow in cleft lip patients.

PURPOSE: This article reports on the modification of the Abbé flap for correction of mild tightness of the corrected cleft lip deformity. PATIENTS AND METHODS: Twelve patients with a moderately tight lip deformity, from 16 to 35 years old, underwent this procedure. Nine had a unilateral deformity and 3 a bilateral deformity. The flap, which was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid's bow. A tiny portion of skin was included to facilitate closure of the donor site. It was inserted into the center of the upper lip and the pedicle was divided 1 week after operation. RESULTS: Each patient showed a more natural contour of the vermilion tubercle and the Cupid's bow. The scarring of the donor site was inconspicuous. CONCLUSIONS: Use of modified Abbé flap to reconstruct the contour of the vermilion tubercle and the Cupid's bow makes the upper lip look more natural.

Effects of growth factors on mucosal scar fibroblasts in culture--a possible role of growth factors in scar formation.

Various growth factors are known to play important roles in wound healing, especially in an early inflammatory phase. However, their roles in subsequent scar formation phase are relatively unexplored. The aim of this study is to investigate the mechanisms of regulation in scar formation by these factors. Scar fibroblasts (SF) were obtained from immature scar tissue made at rat hard palate 1 month after excision and normal fibroblasts (NF) were obtained from the palatal mucosa of untreated control animals. SF showed a longer doubling time, and increased level of protein synthesis when compared to NF. Platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) stimulated [3H]-thymidine uptake less effectively in SF than in NF. In both cells, transforming growth factor-beta 1 (TGF-beta 1) inhibited EGF-induced stimulation of [3H]-thymidine uptake, but had no effects when it was added alone. TGF-beta 1 increased collagen synthesis more effectively in SF than in NF. These data indicate that the growth factors may play key roles in regulating proliferation and metabolic activity of fibroblasts during scar formation.