Transforming Growth Factor-ß3 Therapy Delays Postoperative Reossification and Improves Craniofacial Growth in Craniosynostotic Rabbits.

Postoperative reossification is a common clinical correlate following surgery. It has been suggested that an underexpression of transforming growth factor-ß3 (TGF-ß3) may be related to craniosynostosis and postoperative reossification. Adding TGF-ß3 may delay reossification and improve postoperative growth. The present study was designed to test this hypothesis. Thirty 10-day-old New Zealand white rabbits with hereditary coronal suture synostosis were divided into three groups: (1) suturectomy controls (n = 14), (2) suturectomy treated with bovine serum albumin (n = 8), and (3) suturectomy treated with TGF-ß3 protein (n = 8). At 10 days of age, a 3-mm × 15-mm coronal suturectomy was performed, and serial three-dimensional (3D) computed tomography (CT) scans and cephalographs were taken at 10, 25, 42, and 84 days of age. Calvaria were harvested at 84 days of age for histomorphometric analysis. Mean differences were analyzed using a group by age analysis of variance. Analysis of the 3D CT scan data revealed that sites treated with TGF-ß3 had significantly (P < .05) greater defect areas and significantly (P < .05) greater intracranial volumes through 84 days of age compared with controls. Histomorphometry showed that sites treated with TGF-ß3 had patent suturectomy sites and significantly (P < .001) less new bone in the suturectomy site compared with controls. Serial radiograph data revealed significant (P < .05) differences in craniofacial growth from 25 to 84 days in TGF-ß3-treated rabbits compared with controls. Data show that TGF-ß3 administration delayed reossification and improved craniofacial growth in this rabbit model. These findings also suggest that this molecular-based therapy may have potential clinical use.

Syndromic micrognathia and peri-natal management with the ex-utero intra-partum treatment (EXIT) procedure.

Many advances in healthcare are built on advances in technology. In the case of fetal medicine, technology has availed an entirely new patient population. The authors report a case of severe micrognathia and Pierre Robin Sequence that was diagnosed prenatally. Antenatal planning and treatment were instituted via the Fetal Diagnosis/Treatment Team to avoid loss of the neonate's airway. An EXIT procedure was utilized to ensure a secure airway. The benefits of team care for these types of deformities are highlighted including the importance of craniomaxillofacial specialists.

A protocol for uvulopalatopharyngoplasty, mortised genioplasty, and maxillomandibular advancement in patients with obstructive sleep apnea: an analysis of 40 cases.

PURPOSE: This study evaluated the effectiveness of uvulopalatopharyngoplasty (UPPP) with mortised genioplasty and maxillomandibular advancement (MMA) for the treatment of patients with obstructive sleep apnea not controllable with appliances or continuous positive airway pressure. METHODS: Forty patients with obstructive sleep apnea were evaluated retrospectively. Thirty-three patients underwent combined UPPP and a modified mortised genioglossus advancement. Patients who had specific indications for MMA underwent combined procedures, eliminating staging of multiple surgeries. Seven patients were in this group. All patients were evaluated preoperatively and postoperatively with polysomnography to evaluate the efficacy of the treatment. RESULTS: Mean respiratory distress indices (RDI) and nadir oxyhemoglobin desaturation values were significantly improved with each of the therapies despite many patients having body mass indices significantly greater than the average quoted in other studies. Patients with moderate sleep apnea (RDI, 21 to 40) who underwent UPPP/genioglossus advancement did very well, with 86% of patients achieving success. Patients who underwent MMA all decreased their RDI by at least 56% and had an average improvement of 86%. CONCLUSIONS: The UPPP/mortised genioglossus advancement is effective for the treatment of obstructive sleep apnea. Maxillomandibular advancement is effective for treating severe sleep apnea and may, in some cases, be indicated in combination with UPPP/mortised genioglossus advancement to avoid multiple procedures. Surgical reconstruction of the upper airway is a reasonable approach to the treatment of patients with obstructive sleep apnea, and can be approached more directly to minimize repeated surgical intervention.

Mortised genioplasty in the treatment of obstructive sleep apnea: an historical perspective and modification of design.

We describe a modified technique for mortised genioglossus advancement for treating obstructive sleep apnea and review the history of osteotomies in this region. This new osteotomy technique allows for greater soft tissue advancement of the hypopharyngeal region. Anatomical data from a previous study were used to evaluate the dimensions of the anterior mandible and design an osteotomy that overcomes shortcomings of previous designs. These anatomic measurements enabled us to estimate the size and formulate a design utilized in the anterior mandible for the treatment of obstructive sleep apnea. We believe this design offers the greatest amount of muscular advancement by including genioglossus, geniohyoid, digastric, and mylohyoid. This advancement results in increasing the posterior airway space by volumetric expansion. Custom-designed fixation was utilized to increase stability laterally and decrease the risk of mandibular fracture. The design should be a significant aid in reconstruction of the hypopharyngeal airway in patients with obstructive sleep apnea.

Genioglossus muscle attachments: an anatomic analysis and the implications for genioglossus advancement.

PURPOSE: To determine the exact dimensions of the attachments of musculature to the genial tubercles and to describe their relationships to the anterior mandible. MATERIALS AND METHODS: Ten randomly selected adult cadavers with intact mandibular dentition and without periodontal disease underwent midline sectioning and precise measurements with a caliper to evaluate the dimensions of the attachments of associated musculature. RESULTS: The average thickness of the mandible at the genial tubercle was 12.6 mm. The average thickness of the mandible at the inferior border at pogonion was 14.5 mm. The average distance from the genial tubercle to the inferior border was 14.2 mm. The average distance from the apex of the incisors to the genial tubercle was 11.8 mm. The width of the genioglossus muscle itself was 13.8 mm. CONCLUSIONS: This study precisely evaluates the attachment area of the genioglossus muscle and its relationship to the anterior mandible. These findings help estimate the dimensions of osteotomies made in the anterior mandible for the treatment of obstructive sleep apnea to offer the greatest amount of muscular advancement.

Preprosthetic surgery for the edentulous patients.

Preprosthetic surgery is a rapidly changing area of dentistry. A knowledge of the range, capabilities, and limitations of the commonly used surgical procedures is a must for anyone treating a patient who will receive a complete denture prosthesis. It cannot be overemphasized that the establishment of a clear treatment plan and close coordination of all parties involved in the reconstructive effort are essential to achieve the best overall result.

Viscosity sensing with lamb-wave microsensor: dimethylsulfoxide solution viscosity as a function of temperature.

Recently, a new microsensor employing low-velocity ultrasonic Lamb waves was developed and demonstrated to be capable of measuring the viscosity of solutions in small volumes. The microsensor, when attached to a temperature-controlled stage, can measure viscosity as a function of temperature. In this investigation, the ultrasonic Lamb-wave oscillator is employed to experimentally measure the viscosity of dimethylsulfoxide (Me2SO) solutions as a function of temperature. The microsensor and the experimental procedure are described and results for 1M, 3M, and 5M Me2SO aqueous solutions are presented. Dimethylsulfoxide is a compound commonly employed as a cryoprotectant in cryopreservation, the low-temperature preservation of biological materials. The temperature dependence of viscosity obtained through this study can be used in determining the probability for ice nucleation in biological materials, a parameter of importance during cryopreservation.

Synthesis and antifungal selectivity of new derivatives of amphotericin B modified at the C-13 position.

The syntheses of the first amphotericin B derivatives to be modified solely at the C-13 hemiketal position are described. Selective functionalisation at this position is facilitated by use of the allyl ester as a C-16 carboxylate protecting group on the amphotericin B nucleus. In in vitro tests all compounds showed markedly reduced haemolytic activity against mammalian erythrocytes while two of the novel 13-alkoxy derivatives retained good antifungal activity.