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.

Clinical investigation for bilateral cleft lip repair: modified functional bilateral cleft lip cheilorrhaphy.

PURPOSE: To obtain better operative results, a modified functional bilateral cleft lip (BCL) cheilorrhaphy was designed and used on 131 BCL patients to evaluate the clinical effectiveness in this clinical investigation. A new surgical method would be provided for BCL patients. PATIENTS AND METHODS: Based on the experiences and advantages of the commonly used self-longation and elongation surgical methods for BCL repair, a new surgical method was designed for BCL patients. During the operation, this modified functional BCL cheilorrhaphy emphasized the operative design, anatomy and reposition of musculus orbicularis orbis, management of the maxilla, and reparation of vermilion of the lip. This method was used to repair 131 BCL patients, and the conditions and results of errhysis, swelling, and healing of tresis vulnus were observed and evaluated. RESULTS: This modified functional BCL cheilorrhaphy was used successfully from January 2002 to July 2005 on 131 BCL patients. The wounds of all patients with BCL who joined this study healed very well without any hematoma, infection, or wound decohesion. All of the patients showed symmetric peak of Cupid's bow, obvious philtrum notch, full vermilion of the lip, little scarring, and satisfactory contour. During functional activity, bilateral upper lip was symmetric, coordinated, and balanced. CONCLUSIONS: The clinical results showed that modified functional BCL cheilorrhaphy may be accepted as a good selective surgical technique for BCL patients, and is worth generalization and application.

[HBsAg uptake into human trophoblasts cultured in vitro].

OBJECTIVE: To detect the entry of HBsAg into human trophoblasts cultured in vitro, to provide some clues for the mechanism responsible for HBV intrauterine transmission. METHODS: Digestion with both trypsin (0.25%) and Dnase I(0.15 U/ml) followed by repeated purification was performed to obtain a homogeneous population of trophoblast cells. The well-developed cells during longitudinal phase were randomly divided in 6 groups, which were co-incubated respectively with HBsAg-anti-HBs complex (I), co-culture of heat-inactivated sera positive for HBsAg, HBeAg, and anti-HBc and sera with high titer anti-HBs(II), heat-inactivated sera positive for HBsAg, HBeAg, and anti-HBc(III), HBsAg (IV), heat-inactivated normal sera (V), and normal medium(VI). The coverglasses mounted with confluent cells were harvested for anti-HBs immunohistochemical staining. RESULTS: The isolated cells comprised a highly purified villous trophoblast population and could meet the demands of further experiments. After co-incubation of the cells with different agents, HBsAg test yielded positive results in the cells co-incubated with the HBsAg-anti-HBs complex and in the co-cultures of heat-inactivated sera positive for HBsAg, HBeAg and anti-HBc with sera containing high-titer anti-HBs. HBsAg test was negative in all other cell groups. CONCLUSION: Human trophoblast cells could take in HBsAg in the form of HBsAg-anti-HBs complex instead of single HBsAg molecule.