Interdisciplinary evaluation of consecutive patients with unilateral cleft lip and palate at age 6, 15, and 25 years: a concurrent standardized procedure and documentation by plastic surgeon; speech and language pathologist; ear, nose, and throat specialist; and orthodontist.

PURPOSE: To evaluate surgical results, speech, hearing, and craniofacial morphology after primary cleft repair performed from 1973 to 1979. METHODS: During the years 1972 to 1985, all primary cleft surgeries were performed by 1 plastic surgeon, using Tennison lip closure combined with a periosteoplasty on the clefted alveolus at age 3 months. By mobilizing mucoperiosteal flaps, bony bridges were induced in the alveolar process in approximately 60% of the cases. All patients had the soft palate closed at age 24 months by a pushback technique. All children with complete unilateral clefts without soft tissue bands (unilateral cleft lip and palate) primary operated on 1973 to 1979 were included in the material, except 3 patients with a syndrome and 2 patients of foreign ethnicity. The material involved 30 consecutive patients with unilateral cleft lip and palate (20 boys and 10 girls; 16 left-sided and 14 right-sided clefts) who were operated on. Standardized records including photos, radiographs, lateral cephalograms, plaster model, and recording of speech and hearing were collected according to the treatment protocol at age 6, 15, and approximately 25 years. RESULTS: Evaluation included craniofacial descriptive cephalometric analysis, dentoalveolar morphology, dentofacial aesthetics, speech concerning articulation and nasality, and hearing status. Number of surgical interventions after primary surgery was recorded. Secondary revisions and candidates for orthognathic surgery are reported. Ten consecutive patients (case nos. 11-20) are demonstrated as clinical reports. CONCLUSIONS: : This longitudinal study shows how a multidisciplinary evaluation adequate for intercenter comparison can be performed when standardized procedures, registrations, and documentations are available.

Local and systemic cytokine and chemokine responses after parenteral influenza vaccination.

BACKGROUND AND OBJECTIVE: In this study we investigated the levels of cytokines and chemokines produced locally and systemically after influenza vaccination of patients undergoing tonsillectomy. METHODS: Blood and saliva were collected prior to, and 1 or 2 weeks after vaccination at the time of the tonsillectomy. The cytokine and chemokine concentrations were determined in both unstimulated (whole blood, serum and saliva) and in vitro influenza stimulated peripheral blood mononuclear cell (PBMC) and tonsillar lymphocyte (TMC) cultures. RESULTS: We found that influenza vaccination elicited protective levels of serum haemagglutination inhibition antibodies and a significant local antibody response in the saliva. No significant differences were observed in the cytokine or chemokine levels 1 or 2 weeks post-vaccination in either the serum or saliva. Similarly, no significant differences were found in the gene expression levels in PBMC after vaccination, but interleukin (IL)-2, IL-4, gamma-interferon and transforming growth factor-beta were slightly elevated at 1 week post-vaccination but decreased by 2 weeks post-vaccination. In contrast, increased concentrations of a mixture of type 1, type 2 and inflammatory cytokines were produced 1 and 2 weeks after influenza vaccination by in vitro-stimulated PBMC and TMC. CONCLUSION: We show that cytokine responses can be measured after influenza vaccination in in vitro-stimulated lymphocytes but not directly in the blood or saliva. These results will provide a useful baseline that can be used for comparison of the immune response in human volunteers involved in clinical trials of novel influenza vaccines.

Lymphocyte distribution in the tonsils prior to and after influenza vaccination.

The tonsils, consisting of the adenoid, tubal, palatine and pharyngeal tonsils, form a ring like structure in humans called Waldeyer's ring. The ring of tonsils is rich in lymphocytes and may play an important role as a reservoir of memory and immune competent cells serving the respiratory tract. The tonsils may also function as an activating and effector site for immune responses against respiratory pathogens. In this study, we have examined histological tissue sections from palatine tonsils for influenza specific antibody secreting cells (ASC) and several cell surface markers, from non-vaccinated and influenza vaccinated subjects. We found an increase in the number of influenza specific ASC in the tonsils of the influenza vaccinated subjects. These ASC was found scattered inside and surrounding the germinal centres, indicating that they may have homed to the tonsils. In addition, we observed a significant decrease in CD4 positive cells in tonsils of vaccinated subjects. Similar trends were also detected for CD45RA and CD45RO positive cells, which were significantly reduced in the vaccinated tonsils. The number of macrophages bearing the CD68 surface marker increased in numbers in vaccinated subjects. This shows that dynamic changes takes place in the tonsils after parenteral influenza vaccination, which may point to an important role of the tonsils in combating respiratory pathogens.

Parenteral vaccination against influenza does not induce a local antigen-specific immune response in the nasal mucosa.

The immune response in the nasal mucosa to influenza vaccination in 23 patients scheduled for tonsillectomy was studied. A statistically significant increase in influenza virus-specific serum and oral fluid antibodies was observed 7 days after vaccination. The numbers of influenza virus-specific antibody-secreting cells (ASCs) in peripheral blood also increased significantly 1 week after vaccination. The numbers of ASCs in tonsils and nasal mucosa were compared with data from a recent study of nonvaccinated volunteers. The numbers of influenza virus-specific ASCs in tonsils were significantly higher in the vaccinated group, but, surprisingly, there was no significant difference between the groups in the numbers of ASCs in nasal mucosa. This suggests that the influenza virus-specific antibodies detected in oral fluid are not produced locally in the nasal mucosa and may originate from a systemic source, indicating that the vaccination may favor a systemic immune response.