Neurocognitive development in isolated Robin sequence treated with the Tuebingen palatal plate.

OBJECTIVES: We aimed to determine the neurocognitive development of cleft palate patients with and without Robin sequence (RS). MATERIALS AND METHODS: Children with isolated RS with cleft palate and children with cleft palate only (CPO) were contacted at the age of 5-6 years. All RS children had undergone initial polygraphic sleep study (PG) with a mixed-obstructive apnea index (MOAI) of ≥ 3/h and were consequently treated with the Tuebingen palatal plate. A standardized clinical examination as well as a neuropediatric and neuropsychological examination included the Wechsler Pre-school and Primary Scale of Intelligence (WPPSI-III), Kaufman Assessment Battery for Children (K-ABC), and an assessment of developmental milestones. RESULTS: In total, 44 children (22RS, 22CPO) were included. RS children were younger at study (70.5 ± 7.3 and 75.2 ± 7.5 months; P = .035). Both groups achieved the evaluated milestones within the normed time frame. WPPSI-III and K-ABC results showed no group differences. Mean values for Verbal IQ (101.8 ± 11.1 vs. 97.1 ± 15.7), Performance IQ (102.9 ± 12.1 vs. 99.6 ± 14.5), Processing Speed Quotient (98.9 ± 15.6 vs. 94.5 ± 15.7), Full-Scale IQ (103.2 ± 12.1 vs. 98.4 ± 15.3), and Sequential Processing Scale (102.1 ± 13.1 vs. 94.2 ± 17.3) were within the reference range (IQ 85-115) for RS and CPO children, respectively, indicating average performance of both groups. CONCLUSION: No neurocognitive, physical, or mental impairments were detected suggesting that RS children having upper airway obstruction (UAO) treated early and effectively may use their potential for an age-appropriate neurocognitive development. CLINICAL RELEVANCE: Tuebingen palatal plate treatment successfully releases UAO. Thus, isolated RS does not necessarily result in developmental delay or an impaired neurocognitive outcome. TRIAL REGISTRATION: Deutsches Register Klinischer Studien, DRKS00006831, https://www.drks.de/drks_web/.

Ectomycorrhizal fungal communities of Swiss stone pine (Pinus cembra) depend on climate and tree age in natural forests of the Alps.

Background and Aims: Pinus cembra represent a typical and important tree species growing in European subalpine and alpine habitats. The ectomycorrhizal (ECM) fungal communities associated to this tree under natural conditions are largely unknown. Methods: In this study, we investigated the ECM fungal abundance and composition at four high-altitude sites (two northern-exposed and two southern-exposed habitats) in South Tyrol (Italy), and included also two different age classes of P. cembra. The ECM partners were characterized morphologically, and identified by rDNA ITS sequence analysis. Results: The degree of mycorrhization in adult P. cembra was typically 100% in these natural habitats, with a total species diversity of 20 ECM species. The four high-altitude sites were similar concerning their species richness and mycobiont diversity, but they differed significantly in ECM species composition. Young P. cembra had a mycorrhization degree of 100% and a total of 10 species were observed. All mycorrhizal partners of naturally regenerated young P. cembra were only detected in one specific location, with the exception of Cenococcum sp. and Amphinema sp. which were detected at two sites. Young trees harbour a distinct ectomycorrhizal fungal diversity, which is clearly lower than the diversity detected in adult P. cembra trees. The P. cembra bolete (Suillus plorans) is the most important symbiotic partner of P. cembra at Southern Tyrolean high-altitude sites and is known for its strict, species-specific host association. Conclusions: The ectomycorrhizal fungal community composition strongly depends on geographic region and on the slope exposure (north or south) of the site. Supplementary Information: The online version contains supplementary material available at 10.1007/s11104-022-05497-z.

Three-dimensional assessment of facial development in children with unilateral cleft lip with and without alveolar cleft.

Children with cleft lip or cleft lip and alveolus represent a minor group in the cleft population. The aim of this study was to analyze the faces of these children. In a prospective, cross-sectional study, 344 healthy children and 30 children with cleft lip or cleft lip and alveolus were scanned three-dimensionally at the age of 0 to 6 years. Twenty-one standard anthropometric landmarks were identified, and the images were superimposed. Growth curves for normal facial development were calculated. The facial morphology of cleft children was compared with that of unaffected children.Facial morphology and growth in the transverse direction of the examined patients appeared broadened in all levels. Especially the nasal landmarks indicated a widening of the nose. The landmarks ac l, sbal l, sbal r, c l, sn l, and ls l differed significantly from unaffected children. In the sagittal and vertical dimensions, there was no significant difference compared with unaffected children.Our study demonstrates that surgical and orthodontic treatment can restore the vertical and sagittal dimensions of the face in children with cleft lip with and without alveolar clefts; however, the transverse dimension-especially the nose-remains too broad.

Treatment of obstructive sleep apnea in infants with trisomy 21 using oral appliances.

Objective : To perform a retrospective study to evaluate the effect of oral appliances, aimed at increasing the pharyngeal space, on obstructive sleep apnea (OSA) in infants with trisomy 21 (TS21). Design and Setting : Retrospective study in a tertiary referral center. Intervention : We analyzed data from 51 consecutive infants (mean age, 2.7 months) who underwent polysomnography (PSG) and were offered our treatment concept. Primary study variable was the mixed-obstructive apnea index (MOAI); OSA was defined as a MOAI ≥ 1. Results : Twenty-seven infants (53%) had OSA. Their median MOAI improved from 2.3 (1 to 13) to 0 (0 to 0.2; P < .05). Seven of these infants were treated with an appliance that included some type of velar extension to move the tongue base forward. Of the 24 infants without OSA at admission, follow-up PSG results were available for 13. Three infants from this group had developed OSA by the time of a repeat PSG. Conclusion : In patients with TS21, OSA may already develop in infancy. Early treatment may improve OSA. Oral appliances with some type of velar extension may be considered as an alternative to other treatment procedures.

Speech Development in Cleft Palate with and without Robin Sequence.

BACKGROUND: Robin sequence is defined as the triad of micrognathia, glossoptosis, and upper airway obstruction. In up to 85 percent, it is associated with cleft palate. Many studies have reported worse speech development in Robin sequence children after cleft palate repair. The authors investigated speech development in isolated Robin sequence with cleft palate versus children with cleft palate only at the age of 5 to 6 years. METHODS: All Robin sequence children were treated with the Tübingen palatal plate after birth. Data were collected using the German version of the Great Ormond Street Speech Assessment. Audio and video recordings were reviewed and analyzed separately by two blinded senior phoniatricians based on the German version of the Universal Reporting Parameters for Cleft Palate Speech, and scored to enable comparability of speech outcomes. RESULTS: Forty-four children (Robin sequence, n = 22; cleft palate only, n = 22) were included. Robin sequence children were significantly older at surgery (11.8 months versus 7.1 months; p < 0.001) but younger at study (70.5 months versus 75.2 months; p = 0.035). They also had more severe cleft of the palate (p = 0.006). All children studied showed good to very good speech development without serious impairment. None of the reported parameters on the German version of the Universal Reporting Parameters for Cleft Palate Speech showed significant group differences; the median total score in the Robin sequence group was 23 (interquartile range, 16.5 to 27.5) versus 19 (interquartile range, 17 to 23) in the cleft palate-only group. Statistical analysis revealed no significant effect of group (Z = -1.47; p = 0.14). CONCLUSIONS: No group differences in speech development were found at age 5 to 6 years. Isolated Robin sequence does not necessarily represent a risk for impaired speech development. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Facial surface changes after cleft alveolar bone grafting.

PURPOSE: The aim of this study was to assess the 3-dimensional facial surface changes after cleft alveolar bone grafting with digital surface photogrammetry. PATIENTS AND METHODS: In a prospective study, 22 patients with cleft lip and palate underwent alveolar bone grafting. Before the procedure and 6 weeks postoperatively and before the continuation of orthodontic treatment, 3-dimensional images were taken with digital surface photogrammetry. Seven standard craniofacial landmarks on the nose and the upper lip were identified. Their spatial change because of bone grafting was assessed. Statistical analysis was performed with analysis of variance and t test. RESULTS: A significant increase in anterior projection on the operative side (P < .05) was found for the labial insertion points of the alar base (subalare). No significant changes were detected for the position of the labial landmarks. CONCLUSION: Our results show 3-dimensionally that there is a positive influence of the alveolar bone graft on the projection of the alar base on the cleft side.

An oral appliance with velar extension for treatment of obstructive sleep apnea in infants with Pierre Robin sequence.

OBJECTIVE: A new oral appliance to treat obstructive sleep apnea in infants with Pierre Robin sequence has recently been shown to be superior to a sham procedure. We now investigate safety and long-term effects of this appliance on obstructive sleep apnea in infants with Pierre Robin sequence. DESIGN: Case series with repetitive follow-up examinations. SETTING: Tertiary neonatal intensive care unit at the University Children's Hospital Tuebingen, Germany. PATIENTS: Fifteen infants (11 girls and four boys; median age, 5 days) with Pierre Robin sequence and obstructive sleep apnea (i.e., mixed-obstructive-apnea index > 3). INTERVENTION: A custom-made intraoral appliance with velar extension was used continuously in situ from admission until 3 months after hospital discharge. MAIN OUTCOME MEASURE: The mixed-obstructive-apnea index was determined prior to the intervention at admission, at discharge, and 3 months later using polygraphic sleep studies. The geometric mean of the mixed-obstructive-apnea index and its 95% confidence interval were calculated. RESULTS: Compared with admission (mean, 17.2; 95% confidence interval, 11.1-26.7), there was a significant decrease in the mixed-obstructive-apnea index to discharge (mean, 3.8; 95% confidence interval, 2.2-6.6) and 3 months later (mean, 1.2; 95% confidence interval, 0.7-2.2; p value < .001). No severe adverse events occurred. CONCLUSIONS: This oral appliance was safe and appears to treat obstructive sleep apnea effectively in infants with Pierre Robin sequence.

Perioperative complications in cleft palate repair with Robin sequence following Tuebingen palatal plate treatment.

Our study aimed to evaluate perioperative complications following our institutional pre- and intraoperative management in cleft palate repair with Robin sequence (RS). RS patients who underwent cleft palate repair between 2000 and 2020 were retrospectively analysed. RS children with complete documentation and whose initial treatment involved the Tuebingen palatal plate (TPP) were included. Clinical records and operative charts were reviewed with regard to clinical characteristics as well as the neonatal and perioperative course. Results before and after adjustment of the anesthesiology protocol in 2014 were compared. 143 RS patients (41% male, 59% female) were included. Median pretherapeutic mixed-obstructive apnea index (MOAI) after birth was 9.4/hour (IQR 20.0). TPP treatment was associated with normalisation of the MOAI and adequate weight gain until surgery. At surgery, median age was 10 months (IQR 3), MOAI 0.1/h (IQR 0.5), and weight 8.7 kg (IQR 1.7). In 93% of cases (n = 133), the postoperative course was uneventful. Refinement of the anesthesiology protocol showed positive effects on the perioperative course and led to a reduction in perioperative events (10.7% vs. 2.9%). No severe perioperative complications occurred. We recommend the adoption of TPP treatment in the therapy of RS children. Our favourable results show that early TPP treatment minimizes perioperative complications in cleft palate repair by effectively and sustainably correcting upper airway obstruction.

Three-dimensional assessment of facial development in children with Pierre Robin sequence.

Newborns with Pierre Robin sequence (PRS) have mandibular hypoplasia, glossoptosis, and possibly cleft palate. Their facial appearance is characteristic. The further facial development is controversial. The aim of this study was to analyze the facial development of children with PRS.In a prospective, cross-sectional study, 344 healthy children and 37 children with PRS and cleft palate younger than 8 years were scanned three-dimensionally. Twenty-one standard anthropometric landmarks were identified, and the images were superimposed. Growth curves for normal facial development were calculated. The facial morphology of children with PRS was compared with that of healthy children.The facial growth of children with PRS in the transversal and vertical direction was normal. In the sagittal direction, the mandibular deficit was confirmed. Except for the orbital landmarks and nasion, all landmarks of the midface demonstrated a significant sagittal deficit. This difference to healthy children remained constant for all ages.Our study cannot support the theory of mandibular catch-up growth. The sagittal deficit of the midface could be observed in all ages. This indicates that children with PRS have a very early, severe, and persistent underdevelopment of this part of the face. We conclude that this disturbance must be addressed in early childhood with orthodontic and speech therapy.

Less invasive treatment of sleep-disordered breathing in children with syndromic craniosynostosis.

BACKGROUND: Infants and children with syndromic craniosynostosis (SCS), such as Apert-, Crouzon- or Pfeiffer syndrome, are prone to sleep disordered breathing (SDB) including obstructive sleep apnea and upper airway resistance syndrome (OSAS, UARS), potentially leading to tracheostomy. We modified the Tübingen Palatal Plate (TPP), an oral appliance with a velar extension effectively treating airway obstruction in Robin sequence, by attaching a tube to its velar extension to bridge the narrow pharyngeal airway in SCS patients. Here, we evaluated this treatment concept. METHODS: Our hospital's electronic patient files were searched for all children with a diagnosis of SCS admitted between 01/01/2004 and 31/12/2016. Children with isolated craniosynostosis were excluded. OSAS was defined as a mixed-obstructive apnea-hypopnea index (MOAHI) > 1, and UARS as more than 1 episode with nasal flow limitation/h, but absent OSAS. Children with a diagnosis of OSAS received the TPP and fiberoptic nasopharyngoscopy to assess the type of obstruction and to adjust the plate. Growth and weight gain, determined as standard deviation scores, were also evaluated before and during treatment. RESULTS: Of 34 patients included, 24 presented with SDB (19 OSAS, 5 UARS) and 27 had midface hypoplasia. Proportions of SDB were 78% in those with, and 22% in those without midface hypoplasia. In the OSAS group (n = 19), 13 patients were treated with palatal plates, with the remaining receiving continuous positive airway pressure, midface surgery or tracheal intubation. The MOAHI decreased across all children receiving palatal plate treatment from 14.6 (range 0.0-50.7) at admission to 0.9 (range 0.0-3.5) at discharge (p = 0.002). SDS for weight and body length also improved (p < 0.05 for weight and p = 0.05 for body length). Only one child required tracheostomy. CONCLUSION: Treatment of upper airway obstruction by a modified TPP in these children with SCS was shown to be mostly effective and safe. If confirmed in larger prospective studies, it may help to avoid more invasive interventions.

A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence.

OBJECTIVE: To test the hypothesis that a new orthodontic appliance with a velar extension that shifts the tongue anteriorly would reduce upper airway obstruction in infants with Pierre Robin sequence (PRS). STUDY DESIGN: Eleven infants with PRS (median age, 3 days) and an apnea index (AI) >3 were studied. The effect of the new appliance on the AI was compared with that of a conventional appliance without a velar extension by using a crossover study design with random allocation. RESULTS: Compared with baseline (mean AI, 13.8), there was a significant decrease in the AI with the new appliance (3.9; P value <.001), but no change with the conventional appliance (14.8; P = .842). Thus, the relative change in AI was -71% (95% CI, -84--49) for the new appliance and +8% (95% CI, -52-142) for the conventional appliance, which was significantly different (P = .004). No severe adverse effects were observed. CONCLUSION: This new orthodontic appliance appears to be safe and effective in reducing upper airway obstruction in infants with PRS.

Treatment of infants with Syndromic Robin sequence with modified palatal plates: a minimally invasive treatment option.

BACKGROUND: Infants with Robin sequence (RS) suffer from upper airway obstruction (UAO) and feeding problems. We developed an oral appliance with a velar extension in combination with functional treatment and appropriate feeding techniques, which was proven effective in isolated RS. As the above problems are particularly challenging in syndromic RS, we set out to evaluate our treatment concept also in these patients. METHODS: We searched our electronic departmental database to identify all children admitted to our department between 01/01/2003 and 31/12/2009 because of syndromic RS. UAO was quantified by cardiorespiratory sleep studies performed before and during treatment with a modified palatal plate. This appliance consists of a palatal part, covering the hard palate as well as the alveolar ridges and the potential cleft, and a velar extension shifting the tongue in a more anterior position, thereby opening the pharyngeal airway. It is adjusted by fiberoptic nasopharyngoscopy and controlled by cardiorespiratory sleep studies. Obstructive sleep apnea was defined as a mixed obstructive sleep apnea index (MOAI) >3/h. Feeding modalities before and after treatment and weight gain, determined as standard deviation score, were also evaluated. RESULTS: Of 68 children meeting inclusion criteria, 56 completed treatment (46 of these being infants). Underlying diagnoses included craniofacial dysostosis (N = 13) and synostosis syndromes (N = 5), unspecified dysmorphic syndromes (N = 23) and miscellaneous rare conditions (N = 27). Median MOAI decreased from 8.5 (range 0.3-76.0) at admission to 1.1 (0.0-5.2) at discharge (p < 0.001). 51 children received only a TPP and 5 additionally continuous positive airway pressure (CPAP) or high-flow nasal cannula during sleep for mild residual OSA. Three children ultimately required tracheostomy. The number of exclusively gavage fed infants was reduced from 23 to 7. Conversely, the number of children fed exclusively by mouth increased from 18 to 30. Median SDS for weight decreased from -1.6 (-3.5-1.7) to -1.3 (-4.1-2.5). Twelve children had their treatment prematurely discontinued, e.g. due to laryngeal collapse/laryngomalacia. No patient died during treatment. CONCLUSION: Treatment of UAO and feeding problems in these children with syndromic RS by a modified palatal plate with a velar extension was shown to be effective and safe. If confirmed in prospective studies, it may help to avoid more invasive interventions.

Functional treatment of airway obstruction and feeding problems in infants with Robin sequence.

BACKGROUND: Robin sequence (RS), characterised by micrognathia/retrognathia and glossoptosis with or without cleft palate, presents with intermittent upper airway obstruction and feeding difficulties. Active intervention is required to reduce the risk of brain damage or sudden death. Most treatment options are poorly studied and/or invasive. Our group developed a functional approach including early feeding training and the pre-epiglottic baton plate (PEBP), an orthodontic appliance with a velar extension shifting the base of the tongue forward. PATIENTS AND METHODS: We evaluated the effect of this approach on sleep study results and early weight gain by searching our electronic patient database for infants with isolated RS, born at or referred to our department between 1 January 2003 and 31 December 2012 and treated with the PEBP. RESULTS: Of 122 patients identified, 360 overnight sleep study results, obtained at admission, prior to hospital discharge and 3 months postdischarge, were available (117 infants had complete data). These showed a decrease in the mixed-obstructive apnoea index from (median; IQR) 8.8 (2.1-19.7) to 1.8 (0.6-5.4); p<0.001 and 0.2 (0-1.3); p<0.001, respectively. Z-scores for weight improved from -0.7 (-1.39 to -0.24) upon admission to -0.5 (-0.90 to +0.02) at follow-up (p=0.02), accompanied by a decrease in the proportion of infants requiring nasogastric tube feeding from 66% to 8%. No infant required craniofacial surgery or tracheostomy. CONCLUSIONS: These longitudinal cohort data suggest that this functional approach may be an option to treat both, upper airway obstruction and feeding problems, in infants with isolated RS.

Morphological analysis of the lip and nose following cleft lip repair with simultaneous partial primary rhinoplasty: A prospective study over 4 years.

INTRODUCTION: Facial clefts involve complex abnormalities. The therapy is elaborate, and a critical evaluation of therapeutic outcome is required. Our study analyzed the lip and nose deformities associated with unilateral clefts in a prospective longitudinal study. MATERIAL AND METHODS: A total of 33 patients with a cleft lip or cleft lip and alveolus (UCL) and 46 with a cleft lip and palate (UCLP) were treated using a similar concept. Standardized photographs were taken preoperatively (age 0.4-0.52 years) and again aged 4.04-4.59 years. Anthropometric analyses were performed and compared with age-matched normal values. RESULTS: Nostril width (UCL = 1.01, UCLP = 1.03) and nostril floor width (UCL = 1.02, UCLP = 1.04) were almost symmetric. Nasal tip angles were normalized by surgery. Upper labial height improved, but remained slightly reduced (-4% to -6%). Upper vermillion length was increased (15-17%), and vermillion width was reduced (-12% to -13%) postoperatively. A significantly flatter nostril axis inclination persisted, especially on the affected side (UCL: 37.5°; UCLP: 38.5°), when compared with normal values (53.8°). CONCLUSION: Most cleft irregularities were almost eliminated by therapy; however, the outcome is still not satisfactory for some parameters. The rehabilitation of patients with clefts remains a considerable surgical challenge. Facial anthropometric assessment must play an important role in order to detect and overcome therapeutic shortcomings.

Three-Dimensional Normal Facial Growth from Birth to the Age of 7 Years.

BACKGROUND: With the advent of computer-assisted three-dimensional surface imaging and rapid data processing, oral and maxillofacial surgeons and orthodontists are enabled to analyze facial growth three dimensionally. Normative data, however, are still rare and inconsistent. The aim of the present study was to establish a valid reference system and to give normative data for facial growth. METHODS: Three-dimensional facial surface images were obtained from 344 healthy Caucasian children (aged 0 to 7 years). The images were put in correspondence by means of six landmarks close to the skull base (exocanthion, endocanthion, otobasion inferius). Growth curves for 21 landmarks were estimated in the three dimensions. RESULTS: Facial regions close to the skull base (orbit and ear) showed a biphasic growth pattern, with accelerated growth during the first year of life that subsided to a decreased and linear velocity thereafter. Landmarks on the nose, lips, and chin demonstrated either a curvilinear or a linear growth pattern. CONCLUSIONS: The rapid increase of the orbit and ear region in infancy is a secondary phenomenon to the rapid growth of the neurocranium during the first year of life. Thereafter, maxillary and mandibular growth prevails. The present study gives three-dimensional normative data for an expanded growth span between birth and childhood.

[The Tübingen palatal plate--an innovative therapeutic concept in Pierre-Robin sequence]. / Die Tübinger Gaumenplatte--Ein innovatives Therapiekonzept bei Pierre-Robin-Sequenz.

Infants with Pierre-Robin sequence (PRS) may suffer severe upper airway obstruction resulting in hypoxemia that is difficult to treat. We are currently evaluating a new therapeutic approach involving an oral appliance that widens the pharynx by pulling the base of the tongue forward using a preepiglottic baton. Here we present a patient treated with this device who showed a decrease in his desaturation index from 50 to < 1.

3D soft tissue changes in facial morphology in patients with cleft lip and palate and class III mal occlusion under therapy with rapid maxillary expansion and delaire facemask.

AIM: Rapid Maxillary Expansion (RME) and Delaire facemask are a well-established treatment method for patients with cleft lip and palate and Class III malocclusion. Several roentgenocephalometric studies on skeletal effects of this therapy are known. However, there are no systematic studies on soft tissue changes. The aim of this study was to analyze three-dimensionally the soft tissue changes in facial morphology of children with cleft lip and palate and Class III malocclusion under therapy with RME and Delaire facemask. PATIENTS AND METHOD: A prospective longitudinal clinical trial was undertaken. 29 children between 4.1 and 6.4 years were divided into four groups: eight patients with unilateral cleft lip and palate (group 1), six patients with isolated cleft palate (group 2), eight patients with Class III malocclusion (group 3). The mean treatment period with RME and Delaire mask was 8.2 months. Seven untreated children with no need of orthodontic treatment were chosen as the control (group 4). Two 3D images, one at the beginning and one at the end of the study, were generated with the DSP 400((c)) imaging system. Both images were superimposed ten times and measured ten times. RESULTS: We detected significant forward rotation and forward displacement of the soft tissue in the lower midface with the dentoalveolar areas in all patient groups. No significant asymmetric forward displacement of the soft tissue in the maxilla could be verified in the lower or upper midface, not even in the unilateral cleft lip and palate patients. Among the groups, the Class III malocclusion patients showed greater maxillary soft tissue changes. CONCLUSION: The RME and the Delaire facemask demonstrated the greatest effectiveness in the lower midface soft tissue in terms of forward displacement and forward rotation in the cleft lip and palate patients, particularly in the Class III patients. The 3D data allowed us to discriminatively interpret the effects of the orthopedic mask on the entire maxillary complex and maxillary alveolar process. In the unilateral cleft lip and palate patients, there was descriptively both symmetric and asymmetric advancement of the midface soft tissue.

Implementing a superimposition and measurement model for 3D sagittal analysis of therapy-induced changes in facial soft tissue: a pilot study.

AIM: 3D digital surface photogrammetry is an objective means of documenting the quantitative evaluation of facial morphology. However, there are no standardized superimposition and measurement systems for surveying soft tissue changes. The aim of this study was to present a superimposition and measurement model for three-dimensional analysis of therapy-induced sagittal changes in facial soft tissue and to ascertain its applicability based on the reproducibility of 3D landmark positions. PATIENTS AND METHOD: Twenty-nine children were examined (eight with cleft lip and palate, six with cleft palate, eight with Class III malocclusion and seven healthy controls, between 4.1 and 6.4 years). The mean time between examinations was 8.2 months for the patients and 8 months for the control group. Data was acquired with the DSP 400((c))imaging system. A mathematical model with seven superimposition points was developed. Two 3D images, one at the beginning and the other at the end of the examination, were generated. Both images were superimposed ten times. Ten landmarks for evaluating the soft tissue changes were geometrically defined on the superimposition image, put in place ten times, and measured. The landmarks' reproducibility was calculated via statistical intraoperator analysis. Measurement error was identified using the root mean square error (RMSE). RESULTS: The superimposition points were easy to locate and the landmarks well definable. All midface landmarks proved to be highly reproducible with an RMSE under 0.50 mm. The lower face landmarks demonstrated good reproducibility with an RMSE under 1 mm. The midface landmarks' precision fell below the range of accuracy, while the lower face landmarks' precision fell within the optoelectronic scanner device's range of accuracy (0.50-1 mm). CONCLUSIONS: As an accurate, non-invasive, millisecond-fast, non-ionizing and ad infinitum repeatable procedure, 3D digital surface photogrammetry is very well suited for clinical and scientific application in orthodontics. We developed a reliable superimposition and measurement model with 3D digital surface photogrammetry. This new capturing and measurement system provides a simple means of determining 3D changes in facial soft tissue. Our landmarks proved to be highly reproducible for the midface while revealing good reproducibility for the lower face.

Polygonum viviparum mycobionts on an alpine primary successional glacier forefront.

Polygonum viviparum is one of the first ectomycorrhizal (EM) plant species colonising primary successional sites at the Rotmoos glacier forefront (Tyrolean Alps, Austria). On a site with soil development of about 150 years (2,400 m above sea level), mycobionts of P. viviparum were identified by morphotyping and fungal ribosomal deoxyribonucleic acid internal transcribed spacer sequencing. For studying seasonal dynamics and spatial heterogeneity, ectomycorrhizae were sampled on five plots during all seasons. P. viviparum root tips were always EM. In total, 18 mycobiont taxa of the following genera were identified: Cenococcum (1), Cortinarius (2), Helvella (1), Inocybe (3), Russula (1), Sebacina (2), Thelephora (2) and Tomentella (6). All were non-specific EM partners of EM plants. As early as 2 weeks after spring snow melt, EM were well developed, vital and showed high mycobiont diversity. The relative abundance of senescent root tips was lowest in spring and increased throughout the year, with a maximum in winter (frozen soil). Thus, mycobiont growth and physiological activity obviously start when soil is still under snow cover: We speculate that water availability is one important initiation factor for mycorrhizal development under snow cover, when temperatures still range around the freezing point. Irrespectively of the season, most abundant mycobionts at this primary successional site belonged to the genera Tomentella, Sebacina and Cenococcum, also in frozen soil. Spatial heterogeneity was high when considering species composition and diversity indices. Overall mycobionts species richness was restricted at this site, probably because of the limited availability of fungal partners. We regard the presence/absence of fungal partner and limiting abiotic impacts of the environment as key factors for the symbiotic status of P. viviparum.