Evaluating Quality of Life After Facial Reanimation Using the Facial Clinimetric Evaluation Scale in a Series of Pediatric Patients.

BACKGROUND: Facial palsy can have significant functional and psychological impact. Dynamic facial reanimation methods have provided means of restoration of smile. There remains a dearth of quality of life data in children. The authors aim to assess patient reported outcomes in this underreported population. METHODS: A retrospective review was performed of pediatric patients with facial palsy who had dynamic facial reanimation from 2009 to 2017 at a single institution. Patients were sent a digital Facial Clinimetric Evaluation (FaCE) questionnaire, a validated tool to assess patient quality of life. FaCE statements are grouped into 6 categories: facial movement, facial comfort, oral function, eye comfort, lacrimal control, and social control. RESULTS: Twenty patients met inclusion criteria. Fourteen successfully completed the survey. With normal function being 100, our cohort scored: facial movement 38.7 ±â€Š14.3; facial comfort 67.3 ±â€Š23, oral function 75 ±â€Š22.7, eye comfort 68.75 ±â€Š18.2, lacrimal control 53.6 ±â€Š32.5, social function 64.3 ±â€Š25.6. The overall FaCE score was 61.07 ±â€Š10.85. The facial movement subscores were lower for brow raise 16.1 ±â€Š33.4 relative to smiling 53.6 ±â€Š29.2 and lip pucker, 46.4 ±â€Š23.7. No correlation was found between facial movement scores and total scores (R2 < 0.01). There was a strong negative correlation between total scores and time since procedure (Spearman's rho R =  -0.45). CONCLUSION: Our pediatric facial reanimation cohort demonstrated excellent social function, in contrast to a relatively lower facial movement score. The low facial movement score was mediated by low score for brow raise and was not correlated to overall FaCE score. Interestingly, overall FaCE score tended to decrease with time from procedure.

The Canadian healthy infant longitudinal development birth cohort study: biological samples and biobanking.

BACKGROUND: It is hypothesised that complex interactions between genetic and environmental factors give rise to allergy and asthma in childhood. The Canadian Healthy Infant Longitudinal Development (CHILD) study was designed to explore these factors. METHODS: CHILD is a longitudinal, general population birth cohort study following infants from mid-pregnancy to age 5 years. Over this time period, biological samples, questionnaires, clinical measures and environmental data are collected. RESULTS: A total of 3624 families have been recruited, and many thousands of samples and questionnaires have been collected, annotated, and archived. This report outlines the rationale and methodology for collecting and storing diverse biological samples from parents and children in this study, and the mechanisms for their release for analyses. CONCLUSIONS: The CHILD sample and data repository is a tremendous current and future resource and will provide a wealth of information not only informing studies of asthma and allergy, but also potentially in many other aspects of health relevant for Canadian infants and children.

The limited incision harvest of the rectus femoris flap for complex groin wound management.

BACKGROUND: Muscle flaps can be effective in the protocol of complex groin wound management, yet donor-site morbidity remains a continued concern. The purpose of this study was to present a minimally invasive approach to the harvest of the rectus femoris flap (RFF) for groin wound vascularized tissue coverage. PATIENTS AND METHODS: A retrospective study examined all patients undergoing RFF coverage and reconstruction of a complex groin wound between July 1, 2010, and December 31, 2011. During the study period, the senior author (S.K.K.) performed all RFF harvests through a minimally invasive approach, whereas all other surgeons performed the RFF harvest through a standard approach. Patients who underwent a minimally invasive RFF approach were compared with those who underwent the standard incision. RESULTS: Forty-three patients underwent RFF coverage procedures, 11 of which were carried out using the minimally invasive technique. The patients in the minimally invasive cohort were older (P = 0.03) but had similar rates of medical comorbidities. Minimally invasive RFF harvests were more commonly performed in the planned, salvage setting (P = 0.03). No difference was found in the vascular surgery procedure type (P = 0.13), presence of exposed prosthetic graft material (0.2), or rate of culture-positive wound (P = 0.67). Importantly, no differences in operative time (184.4 [45.5] minutes vs 169.3 [31.7] minutes, P = 0.45) or postoperative complications were observed, with no graft losses or major limb-related morbidity in either group. CONCLUSIONS: The RFF continues to be a workhorse flap for complex groin wounds, most often in the salvage setting. This study demonstrates that a minimally invasive approach can be used for flap harvest with equivalent results to that of the standard longitudinal incision.

Topical vanadate optimizes collagen organization within granulation tissue.

Systemic ingestion of vanadate, a nonspecific inhibitor of tyrosine phosphatases, doubles wound breaking strength, enhances the packing of collagen fibers, and prevents the appearance of myofibroblasts in granulation tissue. Will the local application of vanadate mimic the systemic effects? Pairs of polyvinyl alcohol sponges, each with a central reservoir and attached injection port, were subcutaneously implanted in rats. Daily, one implant received 0.2 ml of saline and the other received 0.2 ml of 0.03 mM vanadate in saline. On day 7, harvested sponges had equivalent wet weights. The vanadate-treated sponges had fibroblasts separated by connective tissue, with a more intense birefringence of the collagen fibers. Transmission electron microscopy showed collagen more uniformly packed in the vanadate treated sponges where collagen fibers were equally spaced and had equal diameters. By immunohistology, myofibroblasts, defined by the expression of alpha-smooth muscle actin within stress fibers, were absent in vanadate-treated granulation tissue. The expression of alpha-smooth muscle actin was restricted to smooth muscle cells of blood vessels. Controls had densely packed alpha-smooth muscle actin staining myofibroblasts, weak birefringence, and randomly spaced collagen fibers with irregular diameters. We conclude that the local application of vanadate prevents the appearance of myofibroblasts and optimizes the organization of collagen fibers in developing granulation tissue.

Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors.

OBJECT: The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas. METHODS: Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F] fluorodeoxyglucose (FDG), [11C]L-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing. CONCLUSIONS: Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.

Fabricating a gold occlusal platform on a removable partial denture to help prevent extrusion of mandibular incisors.

A clinical procedure is presented in which a maxillary removable partial denture (RPD) replacing anterior teeth was fabricated with a cast gold anterior occlusal platform. This treatment is indicated to correct abrasion caused by extruded mandibular anterior teeth on the maxillary RPD. The advantages compared with prosthetic teeth supported by an acrylic resin base or metal-backed facings are discussed. This technique allows for development of optimal esthetics, strength, and durability, while preventing further extrusion and excessive wear of the teeth occluding against prosthesis.

Guided tissue healing for single-tooth implants.

The emergence profile of a single-tooth implant abutment has a significant effect on the esthetics of the final restoration. Most healing abutments are cylindrical, unlike the nonround contours of the natural teeth being replaced. The resulting peri-implant sulcus is round rather than having the correct anatomic cross-sectional shape. This disparity may compromise the ideal emergence profile of the final restoration. This article presents a technique in which a custom abutment and provisional crown or the definitive restoration can be placed at second-stage surgery to guide tissue healing to optimum form and esthetics.

Fabricating a gold occlusal platform on a removable partial denture to help prevent extrusion of mandibular incisors.

A clinical procedure is presented in which a maxillary removable partial denture replacing anterior teeth was fabricated with a cast gold anterior occlusal platform. This treatment is indicated to correct abrasion caused by extruded mandibular anterior teeth on the maxillary removable partial denture. The advantages compared to prosthetic teeth supported by an acrylic resin base or metal-backed facings are discussed. This technique allows for development of optimal esthetics, strength, and durability while preventing further extrusion and excessive wear of the teeth occluding against prosthesis.

Extraction of broken pedicle screws: technical note.

OBJECTIVE: To describe a simple technique for extraction of broken pedicle screw fragments using a high-speed drill and to discuss additional extraction techniques presented in the literature. TECHNIQUE: The broken pedicle screw is removed by drilling a pilot hole with a side-cutting bit next to and along the long axis of the fragment in the superior aspect of the pedicle. The bit is then wedged into the interface between the bone and the proximal screw threads. While the bit is pressed against the threads, the drill is activated in brief pulses. The clockwise rotation of the drill bit engages the threads and backs out the screw fragment RESULTS: This technique has been successfully used in at least two patients with fractured titanium screws allowing placement of larger diameter screws in the same holes. Standard equipment was used, and no complications were encountered. CONCLUSION: Broken titanium pedicle screws can be extracted without damaging the pedicle and without using specialized equipment.

Use of positron emission tomography for presurgical localization of eloquent brain areas in children with seizures.

Successful surgical management of a neoplastic or nonneoplastic seizure focus in close proximity to or within eloquent brain areas relies on precise delineation of the relationship between the lesion and functional brain areas. The aim of this series was to validate the usefulness and test the efficacy of noninvasive presurgical PET mapping of eloquent brain areas to predict surgical morbidity and outcome in children with seizures. To identify eloquent brain areas in 15 children (6 female and 9 male; mean age 11 years) with epileptogenic lesions PET images of regional cerebral blood flow were performed following the administration of [(15)O]water during motor, visual, articulation, and receptive language tasks. These images with coregistered magnetic resonance (MR) images were then used to delineate the anatomic relationship of a seizure focus to eloquent brain areas. Additional PET images using [18F]fluoro-2-deoxy-D-glucose (FDG) and [11C]methionine (CMET) were acquired to help localize the seizure focus, as well as characterize the lesion. Patient surgical management decisions were based on PET mapping in combination with coregistered MR images, PET-FDG findings, and the anatomic characteristics of the lesion. At follow-up 1-26 months after surgery, all patients that underwent temporal lobectomy (9 patients) and extratemporal resection (4 patients) for a neoplastic or nonneoplastic seizure focus are seizure-free with minimal postoperative morbidity. Of prime importance, no child sustained a postoperative speech or language deficit. PET imaging was also well tolerated without procedural complications. Based on PET mapping, a nonoperative approach was used for 2 children and a biopsy only was used in one child. When cortical injury involved prenatally determined eloquent cortex, PET demonstrated reorganization of language areas to new adjacent areas or even to the contralateral hemisphere. Integration of anatomical and functional data enhanced the surgical safety, defined optimal surgical approach, delineated the seizure focus from eloquent brain areas, facilitated maximum resection and optimized the timing of surgery, thereby minimizing surgical morbidity while maximizing surgical goals. PET measurements of FDG and CMET uptake were also helpful in localizing the seizure focus and grading the tumors. PET used for brain mapping in children provides the surgeon with strategic preoperative information not readily attainable with traditional invasive Wada testing or intraoperative cortical stimulation. PET mapping may also improve the outcome of extratemporal resections by allowing aggressive seizure focus resection. In addition, serial brain maps may optimize timing for surgical intervention by demonstrating reorganization of eloquent cortex often seen in younger children after cortical injury. Our results suggest that noninvasive presurgical brain mapping has the potential to reduce risk and improve neurologic outcome.

Use of tissue-tinted porcelain to restore soft-tissue defects.

Anterior, partially edentulous residual ridges often have hard-tissue and soft-tissue defects that create esthetic and functional problems when conventional fixed prostheses are used to replace the missing teeth. However, tissue-tinted porcelain can be used in conjunction with fixed prostheses to solve many of these problems. Proper prosthesis design and shade matching are important considerations in the fabrication of fixed prostheses that incorporate tissue-tinted porcelain to restore hard-tissue and soft-tissue defects.

A one-appointment mouthstick appliance.

Quadriplegics rely on mouthstick appliances to perform a variety of tasks to establish more self-sufficiency. Present techniques to fabricate a quality mouthstick applicance requires professional expertise, time, and laboratory expense. A technique for providing an inexpensive, durable mouthstick appliance in one appointment is described.

Adding retentive features in the rebonding of cast metal resin-bonded prostheses.

Many methods have been used to improve retention in resin-retained fixed prostheses, such as electrolytic etching of the retainer, the labial wrap design, proximal grooves, cast pin retention, and the use of improved adhesive resins such as Panavia EX (Kuraray Co, Osaka, Japan). Insufficient retentive features often lead to debonding of resin-retained fixed prostheses. Debonded prostheses may occasionally be recemented and successfully retained by the addition of retentive features to the prosthesis and abutment teeth. When recementing a debonded prosthesis with questionable retention, additional retention may be added to the retentive wings of the prosthesis by using a Rochette retentive hole in combination with pin retention or enamel/dentinal slots in the abutment teeth.

Microencapsulated human parainfluenza virus induces a protective immune response.

Human parainfluenza type 3 (PI3) virus was incorporated into microspheres composed of a biocompatible and biodegradable DL-lactide and glycolide copolymer. Sera from mice immunized with these microspheres showed an antibody response to the viral glycoproteins and neutralized virus infectivity. The microspheres were also evaluated by intraperitoneal, oral, or intranasal administration to determine their protective efficacy in the hamster. After challenge infection of the intraperitoneally immunized hamsters with live PI3 virus, a significant reduction of virus titers in the respiratory tract was observed, demonstrating the protective efficacy of the microencapsulated viral antigens.

Technique to diminish discomfort from the palatal injection.

A new technique for diminishing the discomfort of a palatal injection has been described. The technique utilizes a cotton pellet saturated with dichlorodifluoromethane spray held in contact with the tissue 5 seconds to freeze a small portion of the surface tissue. The injection needle then penetrates the frozen tissue with little discomfort to the patient.

Evaluation of D-amino acid levels in human urine and in commercial L-amino acid samples.

Detectable levels of four free D-amino acids (phenylalanine, tyrosine, tryptophan and leucine) were found in human urine. This was accomplished using a liquid chromatographic coupled column (i.e., achiral-chiral) method that was developed for the rapid and sensitive analysis of these compounds. The technique was tested on a series of commercial L-amino acids. Care was taken to minimize racemization. Trace to percent levels of contaminating D-enantiomers were found in all commercial samples. In urine the D-amino acids ranged from several hundredths of a percent up to percent levels of the corresponding excreted natural L-amino acids. There were no apparent correlations between the amount of amino acids excreted and the relative amount of D-enantiomers present. Currently this study is being expanded to include additional amino acids and a variety of other physiological fluids.

Cyclodextrin chiral stationary phases for liquid chromatographic separations of drug stereoisomers.

Many active drugs are racemic mixtures. Because the two enantiomers of a racemate often cause different pharmacological responses, the use of optically pure isomers is desirable and may be soon required. Cyclodextrin-bonded silica gel can be used as chiral stationary phase (CSP) in liquid chromatography. The enantiomers of 25 different racemic drugs were separated on such CSPs in the reversed-phase mode. The principal features of the cyclodextrin chiral recognition mechanism are recalled and some information on future trends for cyclodextrin CSPs is provided.

Purification and properties of Aerococcus viridans lactate oxidase.

Lactate oxidase was purified from cells of Aerococcus viridans by a procedure which utilized ammonium sulfate fractionation, DEAE Sepharose CL-6B chromatography, and Sephadex G-100 chromatography. The final preparation was homogeneous by SDS-polyacrylamide gel electrophoresis. The enzyme appears to be a tetramer with a subunit molecular weight of 44,000 and utilizes FMN as a cofactor. The enzyme was highly specific for L-lactate. D-lactate, glycolate, and D,L-2-hydroxybutyrate were not oxidized by the enzyme but were competitive inhibitors. The enzyme could be irreversibly inactivated by incubation with bromopyruvate. This inactivation appears to involve a covalent modification near the active site of the enzyme; however, the flavin cofactor is not the site of this modification.