Bone-anchored maxillary expansion and bilateral interoral mandibular distraction osteogenesis in adult with severe obstructive sleep apnea syndrome.

Severe obstructive sleep apnea syndrome (OSAS) threatens patients' lives. To solve ventilation problem, snoring, and avoid another orthognathic surgery for mandibular advancement, bone-anchored rapid maxillary expansion and bilateral interoral mandibular distraction osteogenesis were tried on a 20-year-old Chinese male patient with severe skeletal class II malocclusion and OSAS.The patient had polysomnography (apnea-hypopnea index 54.2), body mass index measurement (19.7 kg/m), and cephalometry before the treatment. Bone-anchored rapid maxillary expansion was performed for the correction of maxillary transverse and minor sagittal deficiency and the improvement of nasal airflow by decreasing nasal resistance. Bilateral interoral mandibular distraction osteogenesis was operated to lengthen the small, retruded mandible by 15 mm. Orthodontic treatment after the maxillary expansion and mandibular distraction osteogenesis can help obtain stable occlusion.The Epworth Sleepiness Scale, a questionnaire for temporomandibular joint, cephalometric analysis, polysomnography, acoustic rhinometry, and multislice spiral computed tomography were performed to evaluate changes from the treatment. All the results showed that the patient had a significantly alleviated OSAS. In addition, an acceptable occlusion was also obtained.

[A retrospective analysis of 621 cases with craniomaxillofacial fractures].

PURPOSE: To investigate the epidemiological characteristics of 621 hospitalized patients with craniomaxillofacial fractures by a retrospective study. METHODS: From July 2015 to August 2016, the medical records of 621 patients with craniomaxillofacial fractures in Shanghai Ninth People's Hospital were analyzed statistically according to age, gender, etiology and site of fracture. Chi-square test was used to analyze the causes of single and multiple fractures with SPSS 20.0 software package. RESULTS: The male to female ratio was 2.18: 1. The average age was 34.7±15.5 years with 19-29 years old group accounted for the most (28.3%). Traffic accident was the top cause of injury (49.0% ); There were 319 cases of orbital fractures (51.4%), followed by 292 cases of zygomatic complex (47.0%) and 247 cases of mandibular fractures (39.8%). CONCLUSION: The quantity and location of fractures are related to the cause of injury, the nature of stress and anatomical structure of corresponding areas. Establishing a sound system of traffic accident management and related laws is an urgent problem to be solved.

[Evaluation of upper airway and surrounding structures in patients with obstructive sleep apnea using cephalometry combined with Muller's maneuver].

PURPOSE: To evaluate the upper airway and surrounding structures under intraluminal pressure using cephalometry combined with Muller's maneuver in obstructive sleep apnea and hypopnea syndrome (OSAHS) patients with different severity. METHODS: Thirty-nine male patients were enrolled in our department during June 2011 to February 2012. Polysomnography (PSG) and anthropometric measurements data were recorded prior to the study. The lateral cephalograms of each patient were obtained during both the end-expiration phase and Muller's maneuver phase. The patients enrolled were classified into 3 groups according to the results of apnea-hypopnea index (AHI), including mild group (n=11), moderate group (n=14), and severe group (n=14). Craniofacial and upper airway structures were measured in lateral cephalometry by application of Cassos 2001 computed aided measurement software before and after the patients practicing Muller's maneuver. The data was analysed using SAS 9.13 software package. RESULTS: Muller's maneuver had a great influence on the upper airway and surrounding tissue, including increased thickness of the uvula, reduction in the anteroposterior dimension of retropalatal and increased vertical distance of the hyoid bone to the mandible in all groups (P<0.05). In addition, Muller's maneuver also had an impact on the length of the upper airway, which was more significant in severe cases. CONCLUSIONS: Cephalometry combined with Muller's maneuver can display how the intraluminal pressure function on the upper airway and surrounding tissues, and they also can distinguish some minor differences of the upper airway in patients with different security. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (11140902001).

Osteoinduction by Ca-P biomaterials implanted into the muscles of mice.

The osteoinduction of porous biphasic calcium phosphate ceramics (BCP) has been widely reported and documented, but little research has been performed on rodent animals, e.g., mice. In this study, we report osteoinduction in a mouse model. Thirty mice were divided into two groups. BCP materials (Sample A) and control ceramics (Sample B) were implanted into the leg muscle, respectively. Five mice in each group were killed at 15, 30, and 45 d after surgery. Sample A and Sample B were harvested and used for hematoxylin and eosin (HE) staining, immunohistochemistry (IHC) staining, and Alizarin Red S staining to check bone formation in the biomaterials. Histological analysis showed that no bone tissue was formed 15 d after implantation (0/5) in either of the two groups. Newly-formed bone tissues were observed in Sample A at 30 d (5/5) and 45 d (5/5) after implantation; the average amounts of newly-formed bone tissues were approximately 5.2% and 8.6%, respectively. However, we did not see any bone tissue in Sample B until 45 d after implantation. Bone-related molecular makers such as bone morphogenesis protein-2 (BMP-2), collagen type I, and osteopontin were detected by IHC staining in Sample A 30 d after implantation. In addition, the newly-formed bone was also confirmed by Alizarin Red S staining. Because this is the report of osteoinduction in the rodent animal on which all the biotechnologies were available, our results may contribute to further mechanism research.

[Effects of maxillary protraction on craniofacial structures and upper airway dimensions in skeletal Class III malocclusions].

PURPOSE: To evaluate the effect of maxillary protraction on upper airway dimensions in skeletal Class III malocclusions and to investigate the relationship between changes in craniofacial morphology and upper airway dimensions. METHODS: 22 patients who had maxillary retrognathism confirmed by cervical vertebral maturation and treated with face mask protraction. Pre- and post-treatment cephalometric radiographs were analyzed with SAS8.2 software package for paired t test and correlation analysis. RESULTS: The dimensions of PNS-ad1,PNS-ad2,PSP-SPPW, P-MPW increased significantly (P<0.01), Tb-TPPW decreased significantly (P<0.05). The change of V-LPW was not significant (P>0.05).Correlation was found between changes of PNS-Ba and PNS-ad1, PNS-ad2,V-LPW (P<0.05);changes of Hy-H1 and P-MPW,V-LPW (P<0.05);changes of Hy-H0 and V-LPW (P<0.05). No correlation was found between other pharyngeal measurements and investigated craniofacial variables(P>0.05). CONCLUSIONS: Maxillary protraction can affect the upper airway structures. In addition, variables on craniofacial morphology are relative with upper airway dimensions.

[Anatomical changes in upper airway of patients with OSAHS treated with oral appliance].

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is characterized by disturbed sleep, excessive daytime sleepiness and heavy snoring. The possible causes are abnormal upper airway structure and factors of nerves and muscles, etc. Oral appliance is known as an effective treatment on mild and moderate OSAHS. This paper reviews anatomical changes of upper airway structure in OSAHS patients treated with oral appliance. Supported by Shanghai Leading Academic Discipline Project(Grant No.Y0203).

[Uvulopalatopharyngoplasty and maxillomandibular advancement for obese patients with obstructive sleep apnea hypopnea syndrome: a preliminary report].

OBJECTIVE: To evaluate the feasibility and the results of the procedure of maxillomandibular advancement combined with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Nine cases of obese patients with severe OSAHS [age (47.8 +/- 9.7); body mass index (BMI) (35.3 +/- 2.5) kg/m(2); apnea and hypopnea index (AHI) (88.7 +/- 6.7) per hour] underwent the procedure of maxillomandibular advancement (MMA) combined with uvulopalatopharyngoplasty (UPPP). The patients were monitored by polysomnography (PSG) before operation and 3, 6, 12 months after operation, and cephalometric analysis and velopharyngeal closure function were evaluated at the same time. RESULTS: The maxilla was advanced by (8.3 +/- 1.3) mm and the mandible and chin were advanced by (23.0 +/- 2.2) mm. AHI was (2.1 +/- 1.1) per hour post-operation. All patients had no speaking problem and swallowing difficulty and had a good appearance and occlusions. The OSAHS in this group of patients was cured. CONCLUSIONS: Good short-term effects were observed with UPPP and MMA in the treatment of obese patients with severe OSAHS. It did not cause the velopharyngeal closure insufficiency and maxillary necrosis. A long-term follow-up is needed.

[Mandibular advancement devices assisted UPPP for treatment of obstructive sleep apnea and hypopnea syndrome].

PURPOSE: The purpose of this study is to investigate the mechanics of mandibular advancement devices (MAD) assisted uvulopalatopharyngoplasty (UPPP) for treatment of obstructive sleep apnea and hypopnea syndrome (OSAHS). METHODS: 10 patients (8 males, 2 females) were diagnosed as OSAHS by PSG and operated by UPPP. Mandibular advancement devices was used after operation. One month later, all the patients were evaluated by PSG and cephalometric analysis. Paired t test and correlative analysis were carried out using SPSS 10.0 software package. RESULTS: Cephalometric analysis indicated that MCF, angle C3-Rgn-H, Ant In Mx. Ht were significantly different before and after MAD treatment. AHI was correlative with Ant In Mx. Ht and ratio of tongue area and intermaxillary area(P<0.05). CONCLUSIONS: MAD in patients undergoing UPPP results in changes of mandibular position, instead of changes of enlargement of velopharynx. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).

[Filtration characteristics and mechanism of membrane fouling in a membrane bioreactor for municipal wastewater treatment].

Filtration characteristics and mechanism of membrane fouling were investigated with MBR mixed liquor. It was found that, the variation of filtration resistance was fit to the standard blocking filtration model in initial process, and then fit to cake filtration model in later process. In dead-end filtration of sludge, the relative flux was in the tendency to the exponential decay along with filtration time, and flux was decreased more quickly at higher pressure. Sludge was compressed during filtration process, and resistance of sludge was increased with the increase in filtration pressure, the compressibility index was obtained as 0.807 8. Quantitative calculations showed that cake resistance made up over 90% of total resistance. In addition, the relative contribution of each of the sludge fractions to membrane was respectively calculated as 87.98 % for suspended solids, 6.20 % for colloids and 5.82% for solutes. Then a possible mechanism underlying membrane fouling was proposed.

[Distraction osteogenesis for treatment of unilateral temporomandibular joint ankylosis and secondary OSAHS in children: report of 4 cases].

PURPOSE: To evaluate the efficiency of distraction osteogenensis for treatment of unilateral temporomandibular joint ankylosis and secondary OSAHS in children. METHODS: 4 children with temporomandibular joint ankylosis and secondary OSAHS were retrospectively reviewed for their treatment. There were 2 males and 2 females, ranging from 5 to 13 years in age with the median of 6.5 years. Based on the history of the disease, the clinical manifestations, CT scan and PSG findings, the diagnosis was confirmed to be unilateral temporomandibular joint ankylosis and secondary OSAHS. All the patients were treated by gap arthroplasty to restore mouth opening, combined with mandibular body distraction osteogenesis for treatment of OSAHS. One-stage operation was performed on 3 patients, and two-stage operation on 1 patient. Unilateral and bilateral mandibular distraction osteogenesis was undergone on 2 patients individually. At the end of consolidation period of 3 months, the PSG examination was performed again and the distractor was removed. RESULTS: OSAHS was cured, the average AHI was lowered from 42.7 to 4.9, the average lowest saturation of blood oxygen rose from 74.3% to 89.8%, the average incisor distance reached 25.5mm compared to 6.5mm before surgery and facial deformity was corrected satisfactorily. Following up 38.1 months (13-58 months), no relapse appeared. CONCLUSION: Mandibular body distraction osteogenesis, combined with gap arthroplasty, could be the potential treatment modality for children with unilateral temporomandibular joint ankylosis, secondary OSAHS and facial asymmetry; it is recommended that both procedures be performed at the same time.

[Experimental study on distraction osteogenesis for reconstruction of maxillary defects with replacement of transplant disk in goats].

PURPOSE: This study was aimed to set up a new method for reconstruction of maxillary defect with distraction osteogenesis through an animal experiment. METHODS: 11 adult goats were randomly divided into 2 groups (9 in the experimental group and 2 in the control group) in this study. 3 subgroups were set up in the experimental group based on the consolidation period. Other 2 goats were chosen as the control group. Maxillary defect was made firstly through partial maxillectomy for the experimental group. Length of the defects was from 12 to 14mm with an average of 12.7mm. A transport disc was then made through anterior Le Fort I osteotomy and it would be shifted backward for the closure of the defect. Only maxillary defect was made for the control group. Distraction was activated after a latency of 7 days at a rate of 0.4mm twice a day for 15-18 days. RESULTS: Bone defects in the maxilla were well repaired when the transport disc was distracted back to its original position. Radiology and histology demonstrated good new bone formation in the distraction gap. CONCLUSIONS: Transport distraction osteogenesis would be a reasonable method for reconstruction of maxillary defect.

[Influence of dosage on cell biocompatibility of hydroxyapatite/tricalcium phosphate].

OBJECTIVE: To investigate the influence of different dose levels of hydroxyapatite/tricalcium phosphate (HA/TCP) on the proliferation and alkaline phosphatase (ALP) activity of rabbit osteoblasts. METHODS: Three different dose levels of HA/TCP (10%, 40%, 70%) were co-cultivated with rabbit osteoblasts respectively. The proliferation and ALP expression capacity of osteoblasts were examined with MTT method and enzyme histochemistry once every 24 hours until 5 days. Three control groups of other materials were treated and examined in the same way: rabbit osteoblasts as normal control; polyvinylchloride as positive control; titanium alloy as negative control. RESULTS: There was remarkable time-effect relationship in the proliferation of osteoblasts. Ten percent HA/TCP did not affect osteoblasts growth while 40% HA/TCP could slow the cell growth rate down though time-effect relationship still existed. The proliferation of osteoblasts stagnated when co-cultivated with 70% HA/TCP. On the other hand, 10% HA/TCP could cause reversible damage on ALP activity of osteoblasts, whereas when the dose was 40%, and the cultivation lasted 6 days the damage was irreversible. Three different dose levels of titanium alloy (10%, 40%, 70%) had no effect on the proliferation or ALP activity of osteoblasts. CONCLUSION: Dosage is an important factor affecting the biocompatibility evaluation of biomaterial. It suggests that dose choosing should be more specified upon each individual biomaterial. It also indicates that ALP may be a good supplementary index of the cell compatibility of material.

[Treatment of distraction osteogenesis in the patients of obstructive sleep apnea-hypopnea syndrome with micrognathia].

OBJECTIVE: To apply the treatment of distraction osteogenesis(DO) to obstructive sleep apnea-hypopnea syndrome(OSAHS) patients with croniomaxillofacial deformities. METHODS: All 46 OSAHS patients with micrognathia are had polysomnography(PSG) study and cephalometric analysis. Their age from 4 to 18 years old, the mean age is 11.4. The number of temporal mandibular joint (TMJ) ankylosis with micrognathia, micrognathia; 1st & 2nd bronchial arch syndrome and crouzon syndrome patients were 32, 9, 2 and 3 respectively. All were treated with DO. Maxilla or mandible was advanced from 5 to 35 micrometers; the mean advanced distance is 18.34 mm. They were all revaluated by PSG and cephalometric analysis postoperatively. RESULTS: All patients have good respond to the treatment. They have a better appearance and the narrow upper airway was enlarged remarkably, their AHI drop from 66.31 +/- 14.74 pre-operately to 3.16 +/- 1.70 pro-operately, and minimal posterior airway space(PAS) from (5.48 +/- 2.76) mm to (9.97 +/- 2.05) mm. There is remarkable difference (P < 0.001). CONCLUSION: DO is a good method for the patients of OSAHS with micrognathia.