Outcomes of 44 Consecutive Complete Bilateral Cleft Lip and Palate Patients Treated With Secondary Alveolar Bone Grafting and Premaxillary Osteotomy.

OBJECTIVE: To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients. DESIGN: Retrospective review of 44 consecutive patients using hospital notes and radiographs. SETTING: Single specialist cleft lip and palate center, UK. PATIENTS: Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy. OUTCOME MEASURES: Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity. RESULTS: Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized. CONCLUSION: Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.

Early Orthopedic Retraction of the Premaxilla in Bilateral Complete Cleft Lip and Palate: An Innovative Approach to a Difficult Problem.

Bilateral cleft lip and palate occurs in 9.2% of cleft patients. Many approaches have been adopted to manage the protrusive premaxillary segment in patients with bilateral cleft lip and palate. Some advocate the use of intraoral appliances, occasionally combined with invasive surgery, which often requires revision at a later date. The authors describe the case of a 3-year-old child born with bilateral cleft lip and palate presenting with a protuberant premaxilla and an overjet greater than 25 mm. Prompt intervention was warranted in this case due to the potential for traumatic compromise to the dentition of the premaxillary segment and a distinct lack of social integration reported by the parents. The patient was managed with a novel, innovative approach using orthodontic traction and minimally invasive surgery. The literature has been reviewed and the patient's subsequent physiological and psychosocial development has been monitored. He has since undergone successful alveolar bone grafting.

Unauthorized border crossings and migrant deaths: Arizona, New Mexico, and El Paso, Texas, 2002-2003.

OBJECTIVES: We examined the major causes of and risk factors for death among migrants who died while making unauthorized border crossings into the United States from Mexico. METHODS: Decedents were included in the study if (1) their remains were found between January 1, 2002, and December 31, 2003, in any US county along the 650-mi (1040-km) section of the US-Mexican border from Yuma, Ariz, to El Paso, Tex; (2) their immigration status was unauthorized; and (3) they were believed to have died during transit from Mexico to the United States. Characteristics of the decedents and causes of and risk factors for their deaths were examined. RESULTS: Among the 409 decedents meeting our inclusion criteria, environmental heat exposure (n=250; 61.1%) was the leading cause of death, followed by vehicle crashes (n=33; 8.1%) and drownings (n=24; 5.9%). Male decedents (n= 298; 72.8%) outnumbered female decedents (n = 105; 25.6%) nearly 3 to 1. More than half of the decedents were known to be Mexican nationals (n=235; 57.5%) and were aged 20 to 39 years (n=213; 52.0%); the nationality of 148 (36.2%) decedents was undetermined. CONCLUSIONS: Deaths among migrants making unauthorized crossings of the US-Mexican border are due to causes that are largely preventable. Prevention strategies should target young Mexican men, and focus on preventing them from conceiving plans to cross the border, discouraging them from using dangerous routes as crossing points, and providing search-and-rescue teams to locate lost or injured migrant crossers.

Pronounced and prevalent intersexuality does not impede the 'Demon Shrimp' invasion.

Crustacean intersexuality is widespread and often linked to infection by sex-distorting parasites. However, unlike vertebrate intersexuality, its association with sexual dysfunction is unclear and remains a matter of debate. The 'Demon Shrimp,' Dikerogammarus haemobaphes, an amphipod that has invaded continental waterways, has recently become widespread in Britain. Intersexuality has been noted in D. haemobaphes but not investigated further. We hypothesise that a successful invasive population should not display a high prevalence of intersexuality if this condition represents a truly dysfunctional phenotype. In addition, experiments have indicated that particular parasite burdens in amphipods may facilitate invasions. The rapid and ongoing invasion of British waterways represents an opportunity to determine whether these hypotheses are consistent with field observations. This study investigates the parasites and sexual phenotypes of D. haemobaphes in British waterways, characterising parasite burdens using molecular screening, and makes comparisons with the threatened Gammarus pulex natives. We reveal that invasive and native populations have distinct parasitic profiles, suggesting the loss of G. pulex may have parasite-mediated eco-system impacts. Furthermore, the parasite burdens are consistent with those previously proposed to facilitate biological invasions. Our study also indicates that while no intersexuality occurs in the native G. pulex, approximately 50% of D. haemobaphes males present pronounced intersexuality associated with infection by the microsporidian Dictyocoela berillonum. This unambiguously successful invasive population presents, to our knowledge, the highest reported prevalence of male intersexuality. This is the clearest evidence to date that such intersexuality does not represent a form of debilitating sexual dysfunction that negatively impacts amphipod populations.