Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

BACKGROUND/AIM: Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. MATERIALS AND METHODS: This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. RESULTS: A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. CONCLUSIONS: The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Clinical Application of a Resembling Rectangular Flap on Lateral Lip in Unilateral Cheiloplasty: A Modified Millard's Technique.

PURPOSE: This clinical study aimed to design and utilize a modified rotation-advancement technique (MRAT) with a resembling rectangular flap on the lateral lip for primary unilateral cheiloplasty and evaluated its postoperative outcomes. MATERIALS AND METHODS: A retrospective study was conducted on patients with a unilateral cleft lip who had undergone initial cheiloplasty with MRAT. The postoperative outcomes were assessed for nasolabial symmetry by photogrammetry. Repeated measures of ANOVA and two independent samples t tests were applied for statistical analysis. RESULTS: Twenty patients with unilateral cleft lip met the inclusion criteria. Postoperatively, the patients had well-shaped nasal sill and centered nasal columella. In addition to, the bilateral symmetrical ratios noticeably improved ( P <0.001). Simultaneously, the postoperative outcomes were independent of the cleft type and height differences of the two peaks ( P >0.05). CONCLUSIONS: Unilateral cheiloplasty using the present MRAT can better preserve the nasolabial structure and symmetry. The postoperative scar is concealed and simulates a normal philtral ridge.

Analysis of 256 pediatric oral and maxillofacial emergency in-patients during the outbreak of COVID-19.

BACKGROUND/AIMS: Pediatric oral and maxillofacial surgeons have faced severe challenges in ward management due to their high risk of exposure during the COVID-19 epidemic. The aim of this study was to analyze and summarize the treatment methods and infection prevention and control measures applied in emergency cases in the Department of Pediatric Oral and Maxillofacial Surgery, Children's Hospital of Chongqing Medical University, during the COVID-19 epidemic. METHODS: In this retrospective study, information was collected from 256 pediatric emergency patients who were treated from January 23, 2020 to August 9, 2021. The patients' data were statistically analyzed according to age, gender, disease and pathogenesis, operation time, and the main treatment applied in pediatric oral and maxillofacial emergency cases during the COVID-19 epidemic. RESULTS: During the epidemic period, 256 pediatric emergency patients were successfully treated. Among them, there were 170 boys and 86 girls. In all, 182 patients were diagnosed with oral or facial lacerations; 43 had jaw fractures; 26 had maxillofacial infections; and five had dento-alveolar fractures. A total of 246 patients underwent surgery under negative pressure with level 3 protection standards. No doctors or patients infected with COVID-19 were found throughout the stury period. CONCLUSIONS: Pediatric oral and maxillofacial emergency in-patients mainly experienced maxillofacial trauma during the COVID-19 epidemic, followed by infection. Effective diagnosis and treatment, and avoidance of COVID-19 infection can be achieved by strictly following epidemic prevention and treatment procedures.

The Effectiveness of Preoperative Correction Techniques in Improving Nasal Deformity in Children With Unilateral Complete Cleft Lip and Palate.

OBJECTIVE: Unilateral complete cleft lip and palate (UCCLP) is associated with apparent nasal deformities before the cheilorrhaphy. The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral UCCLP used by the systematic review and meta-analysis. METHODS: We searched Medline, Cochrane Library, EMBASE, PubMed, and Chinese BioMedical Literature Database (CBM) until January 31, 2019, to identify studies that compared the effectiveness of preoperative correction techniques in the treatment of nasal deformities in infant with UCCLP. Two authors individually extracted the data and performed the quality assessments. The height of nasal columella, the width of the affected side nasal ala and the inclination of the nasal columella were evaluated. RESULTS: Seven articles were incorporated into the systematic review, and 5 (274 participants) in the meta-analysis according to the inclusion criteria. The preoperative correction could increase the height of nasal columella in children with UCCLP [SMD: 2.64 mm; 95% confidence intervals (CI); (1.35 mm, 3.94 mm); P < 0.0001]. Moreover, the preoperative correction resulted in reduced width of the affected side nasal ala [SMD: -5.14 mm; 95% CI; (-8.96 mm, -1.31 mm); P = 0.008]; However, the evidence was insufficient to determine a significant effect on the inclination of the nasal columella [SMD: -3.48 degrees; 95% CI; (-7.56 degrees, 0.59 degrees); P = 0.09]. CONCLUSIONS: Preoperative correction for children with UCCLP can increase the height of nasal columella, reduce the width of the affected side nasal ala, improve the nasal symmetry, and reduce nasal deformity, however, no significant effect could be observed for the inclination of the nasal columella.

Solitary Myofibroma of the Oral and Maxillofacial Regions in Pediatric Patients: A Clinicopathological Analysis of Ten Patients and Review of 75 Cases.

BACKGROUND: The imaging manifestations of oral and maxillofacial myofibroma/myofibromatosis can vary among patients. Although many clinical cases have been reported, a consensus on the clinicopathological features of and treatment principles for this disease is lacking. PURPOSE: This study aimed to summarize the clinicopathological features of solitary myofibroma of the oral and maxillofacial regions in pediatric patients. METHODS: The clinical data, histological features, and immunohistochemical characteristics of ten pediatric patients who underwent surgical removal and subsequent pathological diagnosis of myofibroma were collected and retrospectively and cross-sectionally analyzed. RESULTS: Seven patients were male, and 3 were female, with ages ranging from 3 months to 6 years (mean: 2.6 years). The patients presented with solitary lesions involving the mandibular gingiva and adjacent mandible (4 patients), mandible (2 patients), oral floor and submandibular area and adjacent mandible (1 patient), gingiva (1 patient), maxilla (1 patient), and oropharynx (1 patient). Light microscopy revealed spindle-shaped tumor cells organized in bundles or vortex patterns, forming a hemangiopericytoma-like perivascular pattern, whereas immunohistochemical staining revealed diffuse smooth muscle actin (SMA) positivity. All patients underwent surgical resection, and none experienced recurrence over the 12- to 82-month follow-up. CONCLUSIONS: Solitary myofibroma in the oral and maxillofacial regions is predominantly observed in infants and young children, with a higher incidence among males. The prognosis is favorable following localized lesion resection or curettage of jawbone lesions. Accurate recognition of the clinical, radiological, and pathological features of the disease will reduce the misdiagnosis rate.

Immortalized Bovine Satellite Cells for Cultured Meat Applications.

For cultured meat to succeed at scale, muscle cells from food-relevant species must be expanded in vitro in a rapid and reliable manner to produce millions of metric tons of biomass annually. Toward this goal, genetically immortalized cells offer substantial benefits over primary cells, including rapid growth, escape from cellular senescence, and consistent starting cell populations for production. Here, we develop genetically immortalized bovine satellite cells (iBSCs) via constitutive expression of bovine Telomerase reverse transcriptase (TERT) and Cyclin-dependent kinase 4 (CDK4). These cells achieve over 120 doublings at the time of publication and maintain their capacity for myogenic differentiation. They therefore offer a valuable tool to the field, enabling further research and development to advance cultured meat.

A comparative study of fluctuating asymmetry in Chinese families with nonsyndromic cleft palate.

OBJECTIVE: To compare the asymmetry displayed by Chinese patients with nonsyndromic cleft palate (NSCP), their unaffected parents, and a control population. METHOD: With rigorous inclusion criteria, a total number of 675 individuals with NSCP, 675 parental pairs of these patients, and 650 control individuals were involved in this case-control study. Size-adjusted fluctuating asymmetry (FA) scores were calculated by data on 10 variables. Analysis of variance was used for a three-way comparison of patients/gender-matched parents/gender-matched controls. RESULTS: A significant increase in FA for ear length (p<.05) was noted in NSCP patients when compared with their gender-matched parents. A significant increase in FA for ear length and palpebral fissure width (p<.05) was observed in NSCP patients when compared with the gender-matched control population. A significant increase in FA for palpebral fissure width (p<.05) was detected in parents of NSCP patients when compared with a gender-matched control population. CONCLUSION: Our results indicated that, when compared with a gender-matched control population, patients with NSCP show significantly increased FA in both ear length and palpebral fissure width, but the parents of patients with NSCP show significantly increased FA only in palpebral fissure width. In general, these characteristics seem to be more distinct in male individuals.

[Diagnosis and treatment of congenital submandibular duct dilatation].

OBJECTIVE: To study the clinical features and treatments of congenital submandibular duct dilatation. METHODS: Seven children with congenital submandibular duct dilatation from January 2008 to March 2018 were included in this study, whose average age was 5 months and 22 days. The clinical manifestations are unilateral swelling of the mouth floor. All seven children underwent sublingual gland resection, submandibular gland dilatation catheter resection, and catheter reroute under general anesthesia. Intraoperatively, the orifice of the submandibular gland was constricted and part of the catheter was dilated. RESULTS: All seven patients had good healing without swelling or cyst formation. CONCLUSIONS: Congenital submandibular duct dilatation occurs at a young age. Early diagnosis and treatment can help prevent further expansion of the catheter and avoid gland atrophy, feeding difficulty, and breathing obstruction. Simultaneous excision of the sublingual gland can avoid the formation of postoperative sublingual cyst.

Effects of different types of palatal lateral excisions on growth and development of maxilla and dental arch.

OBJECTIVE: This study aimed to explore the effects of different types of palatal lateral excisions on the growth and development of the maxilla and dental arch, and to investigate the underlying mechanisms. METHODS: A total of 112 3-week-old Sprague-Dawley (SD) male rats were randomly divided into a control and 3 experimental groups: the mucoperiosteal denudation group, the mucosal flap excision group, and the periosteum excision group. In the experimental groups, bilateral mucoperiosteal, mucosal flap and periosteum were excised respectively in the lateral one half of the palate. Four rats in each group were randomly chosen for sacrifice every two weeks. The maxilla was dissected following the excision. The widths of the maxilla and dental arch were measured and the histological phenomena were investigated at different phases. At the same time, 12 animals in each group were sequentially injected with calcein every two weeks. Three animals in each group, whose fluorescent labeling was used, were sacrificed for investigating bone formation at Week 8 following injection. RESULTS: (1) Each experimental group presented the constriction of the maxilla and dental arch. The upper first molars in the experimental groups inclined medially. The mucoperiosteal denudation group showed the largest degree of effect followed by the periosteum excision group. The indices of the mucosal flap excision group, which retained the structures of the periosteum layer, had the most approximate values to the control group; (2) Different histological changes among the experimental groups were detected. The fibers penetrated into the palatal bone as Sharpey's fibers in the mucoperiosteal denudation group. The pattern of bone deposition was the bundle type. Sharpey's fibers were not found in the mucosal flap and periosteum excision groups and the depositions of palatal bone were the lamellar type as those in the control group; (3) The rates of bone deposition in the experimental groups decreased compared with the control group. The rates in different phases were the most approximate values to those of the control group in the mucosal flap excision group, which has the same structure of periosteum as the control group. CONCLUSION: There were different effects on the growth and development of the maxilla and dental arch in different types of palatal lateral excisions. Periosteum is important for bone formation and deposition pattern. The prevention of Sharpey's fibers forming and attaching to the palatine can effectively avert the following malformation.

Variation trends of the postoperative outcomes for unilateral cleft lip patients by modified Mohler and Tennison-Randall cheiloplasties.

PURPOSE: To evaluate postoperative variation trends of unilateral cleft lip by stages, and to analyze influential factors of nasolabial symmetry. MATERIALS AND METHODS: A total of 145 patients with unilateral cleft lip were treated by the modified Mohler or Tennison-Randall technique, and received routine anti-scarring treatment postoperatively. Photogrammetry was applied to respectively measure 5 indices by stages preoperatively, the first week (1 w), the third month (3 m), the sixth month (6 m), and the first year (1 y) postoperatively. Then we calculated the symmetry ratio and drew line charts. Student t tests were used for any group differences; linear regression analysis was used to examine which postoperative stage correlated best with the preoperative stage; cluster analysis was used to classify the severity of the cleft according to preoperative SRsn-cphi, which was used to predict the operative difficulty and to select an appropriate technique. RESULTS: The Mohler technique yielded a more symmetric result. With the Tennison-Randall technique, the alar base was more lateral and downward, and the lip height on cleft side seemed longer. A stable effect emerged around 1 year after surgery with both techniques. Conspicuous scars appeared at 3 months, most scars gradually fade at 6 months, and the total evolution took around 1 year. Scars from the Mohler technique fluctuated across a larger range. Preoperative SRsn-cphi of the two techniques had statistical significance and was adopted as the basis for cluster analysis. The critical value was 0.670. The Mohler technique attained an almost identical effect in each interval, whereas the Tennison-Randall technique was better in the interval that SRsn-cphi <0.670. CONCLUSIONS: Preoperative SRsn-cphi can be the evaluation index of severity; the modified Mohler technique is more broadly applicable to differences in severity than is the Tennison-Randall technique.

A modified Mohler technique for patients with unilateral cleft lip based on geometric principles--A primary report.

OBJECTIVE: The Mohler technique is one of the most popular methods to repair unilateral cleft lip (UCL) among the modified Millard methods, but it is still imperfect. We successfully designed a modified Mohler method based on geometric principles and observed its clinical effect. MATERIALS AND METHODS: Photogrammetry was performed in 56 patients who underwent UCL repair with the new technique. The symmetry ratios were assessed for sn-cphi, cphi-sbal, ch-sbal, ch-cphi, and vh preoperatively and 1 week after surgery, and were also compared with values in healthy control individuals. RESULTS: Preoperatively, all distances on the cleft side were shorter to different degrees. One week after surgery, results showed well-healed wounds with full, symmetric, and continuous vermilion. On the cleft side, the sn-cphi was 6.13% longer than the non-cleft, and the others were shorter (cphi-sbal: 5.904%; ch-sbal: 1.760%; ch-cphi: 6.234%). The symmetry ratios had differences of significance between preoperative values and those 1 week after surgery (p = 0.000, respectively). Moreover, the vermilion height on the cleft side was 1.026% thicker. When compared with the matched control group, with the exception of SRcphi-sbal (p = 0.072) and SRch-sbal (p = 0.139), there were significant differences (p = 0.000, respectively). All distances in the matched control group were not absolutely symmetric. CONCLUSIONS: The modified Mohler technique seems widely applicable, marking accurate, and less flexible.

[Effective evaluation of presurgical nasoalveolar molding devices in the treatment of complete unilateral cleft lip and palate patients].

OBJECTIVE: To evaluate the orthopedic effect of presurgical nasoalveolar molding (PNAM) devices on the palatal deformities in unilateral complete cleft lip and palate (UCCLP) patients. METHODS: Three groups with 19 patients each were studied. All samples in groups A and B were non-syndromic UCCLP children. Group A was treated with PNAM prior to operation. Group B was untreated prior to operation. Samples in group C were normally developed nose and lip palate infants aged three months. The orthotopic palate photos before and after PNAM treatment for group A, as well as pre-operative photos of groups B and group C, were taken and measured. All statistics were analyzed using SPSS 21.0. RESULTS: PNAM treatment significantly increased the AW, AC, and PA of UCCLP patients (P < 0.05), whereas CPW, CWA, CWAS, CWAH, PMD, and CA significantly decreased (P < 0.05). However, no significant difference was observed with the cases in group C (P < 0.05). The AW, CPW, CA, and PA of the patients in group B significantly increased compared with the cases in group A before PNAM treatment (P < 0.05). Multivariate analysis of variance indicated that TW had no statistically significant difference among the three groups (P > 0.05). CONCLUSION: PNAM treatment is a non-surgical early treatment for the effective improvement of palatal primary deformities in UCCLP patients.

Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: a novel modified presurgical nasoalveolar molding device with retraction screw.

PURPOSE: A novel, modified presurgical nasoalveolar molding (MPNAM) device with retraction screw was designed and used in patients with bilateral complete cleft lip and palate (BCCLP) to rapidly retract and centralize the protuberant and malpositioned premaxilla and correct the nasolabial and palatal deformities. The orthopedic effects and possible complications were evaluated. PATIENTS AND METHODS: Nine patients with BCCLP who met the inclusion criteria were selected. After the maxillary model was obtained, the new MPNAM device with retraction screw was designed and worn until cheilorrhaphy. Changes in local deformities and complications were observed continuously, and the orthopedic effect was evaluated. RESULTS: All patients quickly adapted to the MPNAM appliance, and the treatment was finished after 5-8 return visits. The columella was significantly prolonged, the nasal tip was elevated, and the collapsed nasal dome was obviously improved. Simultaneously, the premaxilla was rapidly retracted and rotated, and gradually centralized; the clefts were gradually reduced and closed, and a nearly normal dental arch was formed. Although there were some complications, the orthopedic treatment was continued until cheiloplasty. CONCLUSIONS: The MPNAM device with retraction screw can simultaneously correct nasolabial and palatal deformities and also rapidly retract and centralize the premaxilla.

[Study on the in vitro effects of dexamethasone at different concentrations on the growth of murine embryonic palatal mesenchymal cell].

OBJECTIVE: To observe the effect of dexamethasone on the proliferation and apoptosis of embryonic palatal mesenchymal (EPM) cells, and chose a proper concentration of dexamethasone which can effect the ordinary growth of embryonic palatal mesenchymal cells. METHODS: The primary EPM cells were isolated and cultured in vitro, then we did biological assay. EPM cells were treated with different concentration dexamethasone (1 x 10(-9), 1 x 10(-8), 1 x 10(-7) and 1 x 10(-6) mol x L(-1)) respectively. The proliferation of EPM cells was evaluated using MTT method. Apoptosis was examined quantitatively with fluorescein stain. RESULTS: In the condition of blood serum's concentration at 10%, optical density step down following the raise of dexamethasone's concentration. The effect of dexamethasone got to a summit at 3 days. Inhibition rate of dexamethasone at 1 x 10(-6) mol x L(-1) was the highest. CONCLUSION: Dexamethasone at 1 x 10(-6) mol x L(-1) can not only inhibit the growth of the EPM cells, but also will not lead to a large number of cells death. Therefore, this concentration can be used as a reference standard in future research. The most significant drug action time of dexamethason appears at the third day after administration, then the effect became weaken following the drug metabolism.

Animal experimental study on repairing alveolar clefts by using rectilinear distraction osteogenesis.

The aim of this study was to evaluate the clinical applicability of rectilinear distraction osteogenesis for repairing alveolar cleft models. Alveolar process distraction surgery to produce bilateral clefts was performed on six adult cats. In our study, the left side with the distraction device was the experimental side, and the other side without a distraction device was the control side. After a 6-day latent period, animals underwent gradual distraction at a rate of 0.6mm per day (distraction was performed twice each day, at a rate of 0.3mm each time), until the tissue on the two sides of the cleft touched, then the distraction strength was maintained for 2 days. Two cats were sacrificed at 2 weeks, 6 weeks and 10 weeks postoperatively. Gross anatomical, histological and radiographical analyses were performed after the animals were sacrificed. In addition, the arch width was measured both before setting the distraction device and after distraction was complete. Two weeks after the distraction was complete, the soft tissue of the two sides of the cleft region on the experimental side touched, and it began to coalesce. The extremities of the two sides of the cleft region on all the experimental sides drew close to each other, but there was no bony conjunction. New bone formation appeared in the distraction region. The arch width at the front of the maxillary bone on the distraction side after distraction was smaller than before distraction. The alveolar cleft could be closed by rectilinear distraction osteogenesis. Two sides of the cleft touched each other and only soft tissue coalesced, but we did not observe bone coalescing. This phenomenon suggested that it might be difficult to achieve complete bony repair by rectilinear distraction osteogenesis. However, rectilinear distraction osteogenesis can minimise the size of the alveolar cleft and make bone grafting advisable for those patients who are not suitable for bone grafting before distraction osteogenesis.