Orthodontic and Orthognathic Treatment Combined withSurgically Assisted Rapid Maxillary Expansion in an Adult Patient with a Hyperdivergent Skeletal Pattern.

In this case study, we report the successful treatment of a 35-year-old woman with a hyperdivergent skeletal pattern, open bite and severe transverse deficiency, exhibiting a skeletal Class III malocclusion. The treatment plan included 3D correction of these issues with surgically assisted rapid maxillary expansion (SARME) to solve the transverse deficiency, presurgical orthodontic treatment including aligning and levelling of the teeth in both arches, LeFort I osteotomy and bilateral sagittal split ramus osteotomy, and postsurgical correction of malocclusion. Orthodontic treatment was performed with labial brackets, and the patient achieved satisfactory occlusion and a significantly improved facial profile. Retention at the 1-year follow-up showed stable occlusion and arch forms with a harmonious facial profile.

MicroRNA-328-5p Alleviates Macrophage Lipid Accumulation through the Histone Deacetylase 3/ATP-binding cassette transporter A1 pathway.

MicroRNA-328 (miR-328) was reported to protect against atherosclerosis, but its role in foam cell formation remains unknown. The aim of this study was to investigate the effect of miR-328-5p on macrophage lipid accumulation and the underlying mechanisms. The results showed that miR-328-5p expression was robustly decreased in oxidized low-density lipoprotein (ox-LDL)-treated macrophages. Treatment of human acute monocytic leukemia cel (THP-1) macrophage-derived foam cells with a miR-328-5p mimic markedly increased [3 H]-cholesterol efflux, inhibited lipid droplet accumulation, and decreased intracellular total cholesterol (TC), free cholesterol (FC) and cholesteryl ester (CE) contents. Upregulation of miR-328-5p also reduced the expression of histone deacetylase 3 (HDAC3) but increased the levels of ATP-binding cassette transporter A1 (ABCA1) in THP-1 macrophage-derived foam cells. Mechanistically, miR-328-5p inhibited HDAC3 expression by directly targeting its 3'UTR, thereby promoting ABCA1 expression and the subsequent cholesterol efflux. Furthermore, miR-328-5p mimic treatment did not affect the uptake of Dil-ox-LDL or the expression of scavenger receptor-A (SR-A), thrombospondin receptor (CD36) and ABCG1. Taken together, these findings suggest that miR-328-5p alleviates macrophage lipid accumulation through the HDAC3/ABCA1 pathway.

Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography.

OBJECTIVES: To establish one method that can be used to quantitatively evaluate the condyle positional changes with 3D images in postoperative mandibular prognathism patients. MATERIALS AND METHODS: This is a retrospective observational study. Twenty-one patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) were scanned with cone beam computed tomography (CBCT) for temporomandibular joints (TMJs) at 1 week preoperatively (T0), 1 to 2 weeks (T1), 3 months (T2), 6 months (T3), and 12 months (T4) postoperatively. The data were then grouped into T0T1, T1T2, T2T3, T3T4 and T0T1, T0T2, T0T3, and T0T4. Semi-automatic registration was conducted, and the condyle positional changes were measured in segmented 3D models. Inter- and intra-observer variability and the repeatability of registration were analyzed with paired t test; the repeated measurement analysis of variance was used for analyzing the repeatability of the marked points; the consistency of segmentation was analyzed with nonparametric test of multiple paired samples (Friedman test) and the independent-sample t test was applied to comparing changes between different periods of time. Differences were considered to be statistically significant when P < 0.05. RESULTS: In T0T1 and T1T2, the condylar position was changed greatly. In T2T3, the mean condylar translations were less than 0.2 mm in all directions, the mean rotational changes of condyle were less than 0.2 mm; in the period of T3T4, the mean condylar translations in all directions were less than 0.02 mm. For series 2, the condyle translational changes in axial, coronal, and sagittal views were within 0.10 mm, and the rotation direction of condyle in all three views was the same within 1 year after operation. CONCLUSIONS: Fused three-dimensional images can be used to qualitatively and quantitatively evaluate condyle positional changes. The condylar position might be stable at 3 months postoperatively. The condyles of most of patients did not fully return to their preoperative position within 1 year after the operation. CLINICAL RELEVANCE: One method for fusing images has been established to detect the condylar positional changes. This method may be applied to estimate the bony changes of condyle, even bony changes in other part of dentomaxillofacial region. Meanwhile, the data of condyle positional changes from asymptomatic patients after the surgery within 1 year can be used as a reference for further exploration of the relationship between orthognathic surgery and the occurrence of osteoarthritis postoperatively in the future. KEY POINTS: • By fused 3D images, the change of condylar position after bilateral sagittal split ramus osteotomy can be observed intuitively. • For the patients with mandibular prognathism, the condylar position would be stable at 3 months postoperatively. • The condyles of most mandibular prognathism patients did not fully return to their preoperative position within 1 year after operation.

Gastrodin combined with rhynchophylline inhibits cerebral ischaemia-induced inflammasome activation via upregulating miR-21-5p and miR-331-5p.

BACKGROUND: The protective effects of gastrodin and rhynchophylline in ischaemic injury have been reported. However, the underlying mechanism and the effect of the combination of these two drugs in ischaemic injury remain unclear. Herein, we aimed to explore the effects of the combination of gastrodin and rhynchophylline on ischaemia-induced inflammasome activation as well as the underlying mechanism. METHODS: Middle cerebral artery occlusion (MCAO) mice and oxygen glucose deprivation (OGD)-treated BV2 cells were used as in vivo and in vitro models of ischaemia, respectively. Cerebral injury was determined by TTC staining, H&E staining and neurological deficit scores. The effects of the combination of gastrodin and rhynchophylline on inflammasome activation were measured by the MTT assay, Western blotting and ELISA. The expression of miR-21-5p and miR-331-5p was measured by qRT-PCR. The potential binding between miR-21-5p and TXNIP and between miR-331-5p and TRAF6 was analysed with Targetscan and a luciferase assay. RESULTS: MCAO-induced tissue infarction, neurological deficits, inflammasome activation, and downregulation of miR-21-5p and miR-331-5p were all mitigated by the combination of gastrodin and rhynchophylline. In OGD-treated BV2 cells, the combination of gastrodin and rhynchophylline also alleviated inflammasome activation and restored the expression of miR-21-5p and miR-331-5p. TXNIP and TRAF6 were confirmed to be targets of miR-21-5p and miR-331-5p, respectively. Moreover, OGD-induced inflammasome activation was attenuated by the overexpression of either miR-331-5p or miR-21-5p and was further attenuated by the overexpression of both. Finally, we demonstrated that a miR-21-5p inhibitor and/or a miR-331-5p inhibitor counteracted the protective effects of gastrodin and/or rhynchophylline. CONCLUSIONS: The combination of gastrodin and rhynchophylline exerts neuroprotective effects by preventing ischaemia-induced inflammasome activation via upregulating miR-21-5p and miR-331-5p.

FGFR2 mutation in a Chinese family with unusual Crouzon syndrome.

AIM: To describe the clinical characteristics with genetic lesions in a Chinese family with Crouzon syndrome. METHODS: All five patients from this family were included and received comprehensive ophthalmic and systemic examinations. Direct sequencing of the FGFR2 gene was employed for mutation identification. Crystal structure analysis was applied to analyze the structural changes associated with the substitution. RESULTS: All patients presented typical Crouzon features, including short stature, craniosynostosis, mandibular prognathism, shallow orbits with proptosis, and exotropia. Intrafamilial phenotypic diversities were observed. Atrophic optic nerves were exclusively detected in the proband and her son. Cranial magnetic resonance imaging (MRI) implied a cystic lesion in her sellar and third ventricular regions. A missense mutation, FGFR2 p.Cys342Trp, was found as disease causative. This substitution would generate conformational changes in the extracellular Ig-III domain of the FGFR-2 protein, thus altering its physical and biological properties. CONCLUSION: We describe the clinical presentations and genotypic lesions in a Chinese family with Crouzon syndrome. The intrafamilial phenotypic varieties in this family suggest that other genetic modifiers may also play a role in the pathogenesis of Crouzon syndrome.

[Effect of segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy on the condyle position in skeletal class III malocclusion patients].

OBJECTIVE: To investigate the effect of segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) on the condyle position in skeletal class III malocclusion patients. METHODS: In this retrospective study, 19 patients with skeletal class III malocclusion who met the inclusion criteria were enrolled. All the patients underwent the segmental Le Fort I osteotomy and BSSRO. Cone beam computed tomography (CBCT) scans were performed in the following phases: T1: within one week before the surgeries; T2: within one week post-surgery;T3:three months post-surgery; T4: 6 to 14 months post-surgery. The posterior spaces, anterior spaces and the superior spaces of the bilateral temporomandibular joints were measured according to the Kamelchuk method respectively. The fossa ratios of the condyle and the distribution of the condyle positions related to the glenoid fossa (anterior, concentric and posterior position)were calculated. The results were analyzed statistically. RESULTS: The posterior space, the anterior space and the superior space of bilateral temporomandibular joints in T2 phase[right: (2.78±1.23) mm, (2.47±0.89) mm, (3.07±0.85) mm; left: (2.93±0.83) mm, (2.69±1.14) mm, (3.44±1.16) mm] showed significantly larger spaces than those in T1 phase [right: (1.81±0.95) mm, (1.65±0.55) mm, (2.13±0.52) mm; left: (2.12± 1.05) mm, (1.79±0.59) mm, (2.15±0.93) mm],in T3 phase [right: (2.08±1.25) mm, (1.79±0.68) mm, (1.80±0.76) mm; left: (2.05±0.75) mm, (1.99±0.94) mm, (2.14±0.71) mm] and in T4 phase [right: (1.94±0.77) mm, (1.81±0.69) mm, (2.05±0.69) mm; left: (1.89±0.69) mm, (1.80±0.61) mm, (2.19±0.75) mm], P<0.05. No significant differences were observed among T1,T3 and T4 phases in the terms of the joint spaces of both sides(P>0.05).The fossa ratio and the condyle position related to the glenoid fossa had no significant difference in all the four phases (P>0.05).The results suggested that the condyle moved downward in T2 phase and changed to the original pre-surgery position in T3 phase, then keot stable in T4 phase. CONCLUSION: Segmental Le Fort I osteotomy and BSSRO caused significant and transient changes of the condyle position in skeletal class III malocclusion patients. However, the condyle tended to move back to the original pre-surgery position and might keep stable.

[Three-dimensional evaluation of condylar morphology remodeling after orthognathic surgery in mandibular retrognathism by cone-beam computed tomography].

OBJECTIVE: To evaluate the effect of orthognathic surgery on condylar morphology changes by comparing three-dimension surface reconstructions of condyles using cone-beam computed tomography (CBCT) data. METHODS: In the study, 18 patients with mandible retrognathism deformities were included and CBCT data of 36 temporomandibular joints were collected before surgery and 12 months after surgery. Condyles were reconstructed and superimposed pre- and post-operatively to compare the changes of condylar surfaces. One-sample t test and χ2 test were performed for the analysis of three-dimension metric measurement and condylar head remodeling signs. P<0.05 was considered significant. RESULTS: The root-mean-square (RMS) of condylar surface changes before and after the surgery was (0.37±0.11) mm, which was significant statistically (P<0.05). The distribution of condylar remodeling signs showed significant difference (P<0.05). Bone resorption occurred predominantly in the posterior area of condylar head and bone formation occurred mainly in the anterior area. CONCLUSION: Three-dimension superimposition method based on CBCT data showed that condylar morphology had undergone remodeling after mandibular advancement.

Screening Allelochemical-Resistant Species of the Alien Invasive Mikania micrantha for Restoration in South China.

To screen allelochemical-resistant species of the alien invasive weed Mikania micrantha, we studied the allelopathic inhibition effects of the leaf aqueous extract (LAE) of Mikania on seed germination and seedling growth of the 26 species native or naturalized in the invaded region in South China. Seed germination was more strongly negatively affected by LAE than seedling growth. Responses of seed germination and seed growth to LAE differed differently among the target species. LAE more strongly negatively affected seed germination, but less strongly negatively affected seedling growth, in non-legume species than in legume species. LAE more strongly negatively affected seed germination and seedling growth in native species than naturalized exotic species. Therefore, naturalized exotic non-legume seedlings are more suitable than seeds of native legume species for restoration of Mikania-invaded habitats.

Modified method of recording and reproducing natural head position with a multicamera system and a laser level.

INTRODUCTION: As computer-assisted surgical design becomes increasingly popular in maxillofacial surgery, recording patients' natural head position (NHP) and reproducing it in the virtual environment are vital for preoperative design and postoperative evaluation. Our objective was to test the repeatability and accuracy of recording NHP using a multicamera system and a laser level. METHODS: A laser level was used to project a horizontal reference line on a physical model, and a 3-dimensional image was obtained using a multicamera system. In surgical simulation software, the recorded NHP was reproduced in the virtual head position by registering the coordinate axes with the horizontal reference on both the frontal and lateral views. The repeatability and accuracy of the method were assessed using a gyroscopic procedure as the gold standard. RESULTS: The interclass correlation coefficients for pitch and roll were 0.982 (0.966, 0.991) and 0.995 (0.992, 0.998), respectively, indicating a high degree of repeatability. Regarding accuracy, the lack of agreement in orientation between the new method and the gold standard was within the ranges for pitch (-0.69°, 1.71°) and for roll (-0.92°, 1.20°); these have no clinical significance. CONCLUSIONS: This method of recording and reproducing NHP with a multicamera system and a laser level is repeatable, accurate, and clinically feasible.

[Comparison of three surgical techniques for controlling nasal width after Le Fort I osteotomy].

OBJECTIVE: To identify nasal width changes occurring after Le Fort I osteotomy and to compare prospectively the effect of three surgical techniques for controlling postoperative nasal width. METHODS: In the study, 79 patients (22 male and 57 female, mean age 23.2 ± 3.4 years), who received Le Fort I osteotomy at Peking University Hospital of Stomatology from 2011 to 2014, were randomly divided into three groups. Group 1 was treated with traditional intraoral alar base cinch suture (ABCS); Group 2 with extraoral ABCS, and Group 3 with traditional ABCS plus an extra intraoral suture at points G.lat. All the patients had taken 3D photos using 3dMD camera before operation, and 3, and 6 months after operation. The nasal widths, which were indicated as distances between Sbal-Sbal, G.lat-G.lat and Al-Al, were measured by two examiners in the 3D photos three times with a time-interval of one week. SPSS 13.0 was used to do the statistic analysis. RESULTS: At the end of the postoperative 6 months, the nasal widths lessened as compared with the postoperative 3 months. No significant differences were found between the three groups 6 months after the operation. The degree of the postoperative nasal width widening had positive correlation with that of the intraoperative nasal width widening, and had negative correlation with the initial nasal width and the amount of post-suture narrowing. CONCLUSION: There is no difference between three suturing techniques for controlling nasal width widening after Le Fort I osteotomy. The postoperative nasal width-widening can't be totally avoided, and the alteration might last at least 6 months after the operation. For patients with narrow nasal width and need to move maxilla forward, more overcorrection of ABCS is needed to control the postoperative nasal base widening.

TolC promotes ExPEC biofilm formation and curli production in response to medium osmolarity.

While a high osmolarity medium activates Cpx signaling and causes CpxR to repress csgD expression, and efflux protein TolC protein plays an important role in biofilm formation in Escherichia coli, whether TolC also responds to an osmolarity change to regulate biofilm formation in extraintestinal pathogenic E. coli (ExPEC) remains unknown. In this study, we constructed ΔtolC mutant and complement ExPEC strains to investigate the role of TolC in the retention of biofilm formation and curli production capability under different osmotic conditions. The ΔtolC mutant showed significantly decreased biofilm formation and lost the ability to produce curli fimbriae compared to its parent ExPEC strain PPECC42 when cultured in M9 medium or 1/2 M9 medium of increased osmolarity with NaCl or sucrose at 28°C. However, biofilm formation and curli production levels were restored to wild-type levels in the ΔtolC mutant in 1/2 M9 medium. We propose for the first time that TolC protein is able to form biofilm even under high osmotic stress. Our findings reveal an interplay between the role of TolC in ExPEC biofilm formation and the osmolarity of the surrounding environment, thus providing guidance for the development of a treatment for ExPEC biofilm formation.

[Establishment and accuracy examination of gyroscope for recording and transferring natural head position].

OBJECTIVE: To build up and validate a system based on gyroscope to record human natural head position (NHP) and to transfer it into virtual surgical design system. METHODS: Three dimensional (3D) mechanical gyroscope and 3D design software were integrated in the system. The protocol for recording and transforming NHP included four steps. Firstly, the gyroscope was CT scanned when its position was (0, 0, 0), a virtual model was built up by 3D reconstruction and considered as standard gyroscope model. Secondly, the gyroscope was bounded to the patient's head using bite-jid and face bow. The NHP was recorded when the patient was looking himself into mirror. Thirdly, the virtual head of the patient was overlapped with standard gyroscope model. Finally, when pitch, roll and yaw of NHP were applied to the compound model, the virtual head was orientated to NHP. A standard cube model was used to validate the accuracy of the system. The cube was positioned 30 times, the real and virtual pitch, roll and yaw angles were recorded. The accuracy of the system was presented by the mean ± SD of the Delta. the difference between the real and virtual pitch, roll and yaw angles were analyzed by paired t test,and their correlations were investigated by Pearson test. RESULTS: The accuracy rates of the system were ΔPitch = 0.03 ± 0.28°,ΔRoll = 0.03 ± 0.23°,ΔYaw = 0.07 ± 0.49°. There were no significant differences between the real and virtual pitch, roll and yaw angles (P > 0.05). The two positions were absolutely correlated at the level of α = 0.01 (2-tailed, r = 1.00). CONCLUSION: The method of recording and transforming NHP using gyroscope is clinically applicable. The accuracy of transferring system meets the needs of virtual surgical design.

[Clinical application of condylectomy via intraoral approach under computer assisted surgical navigation].

OBJECTIVE: To assess the application of computer assisted surgical navigation in condylectomy via intraoral approach and its clinical results. METHODS: Eight patients aged from 16 to 56 were treated by condylectomy via intraoral approach under computer assisted surgical navigation. There were 6 female and 2 male. The lesions were condyle osteoma in 3 patients, hemimandibular hyperplasia and condylar hyperplasia in 5 patients. Most patients had concomitant LeFortIosteotomy (6 cases), bilateral sagittal split ramus osteotomy (BSSRO) (5 cases),contralateral sagittal split ramus osteotomy (SSRO) (1 cases), genioplasty (4 cases) and mandible contouring (6 cases) to recover the facial symmetry. RESULTS: All patients had good occlusion, oral function and facial symmetry after the operation. The average mouth opening was 38 mm before operation, and 41 mm one month after operation. The temporomandibular joint(TMJ) dysfunction syndrome alleviated or disappeared. The follow-up period was 3-12 months, and results were stable. CONCLUSIONS: Computer assisted surgical navigation can precisely accomplish the condylectomy via intraoral approach.It causes less trauma to the patient than traditional condylectomy, and can better preserve the TMJ structure and function.

[Association study of insulin-like growth factor-1 polymorphisms with extreme high myopia].

OBJECTIVE: To investigate whether the polymorphisms of insulin-like growth factor-1 (IGF-1) gene and its regulatory regions are associated with extreme high myopia. METHODS: A case-control analysis of 302 subjects with extreme high myopia and 401 controls was undertaken. Genomic DNA was obtained from peripheral blood. Seven tag single nucleotide polymorphisms (tSNP) across the IGF-1 gene region were selected to capture the majority of genetic variation. All tSNP were genotyped using the MassArray platform and MALDI-TOF analysis. Genotypic distribution was tested for Hardy-Weinberg equilibrium. Statistical analyses were performed using the SPSS (version 13.0: SPSS Science, Chicago, IL) software. The genotype and allele frequencies were evaluated using the χ(2) tests and performed by Bonferroni corrections for multiple comparisons. The significance of the differences in the estimated haplotype frequencies between the myopia and control groups was examined on Haploview 4.2 using χ(2) tests, and haplotypes were corrected by using permutation test after running 50 000 times. RESULTS: Among seven different IGF-1 tSNP tested, the allele frequencies of four tSNP-rs5742629(A/G), rs12423791(G/C), rs35766 (G/A) and rs1457601(T/A) in the myopia and the control groups were A(56.5%, 62.3%)/G(43.5%, 27.7%), G(70.4%, 77.1%)/C(29.6%, 22.9%), G(33.9%, 28.8%)/A(66.1%, 71.2%), T(72.5%, 77.3%)/A(27.5%, 22.7%), respectively. And they showed significant differences (χ(2) = 4.968, 8.059, 4.250, 4.245, P < 0.05) between the two groups. However, only rs12423791 remained significance after Bonferroni correction. The haplotype GC of rs5742629-rs12423791 was associated with extreme high myopia (P = 0.033) after 50 000 permutations for multiple comparisons as well. CONCLUSIONS: The polymorphism of rs12423791 in IGF-1 may be associated with extreme high myopia in the Chinese population.

[Clinical application of transport distraction osteogenesis arthroplasty in the treatment of temporomandibular joint bony ankylosis].

OBJECTIVE: To explore the clinical application of transport distraction osteogenesis arthroplasty (TDOAP) in the treatment of temporomandibular joint (TMJ) bony ankylosis. METHODS: From December 1999 to December 2011, a total of 73 patients (89 sides of TMJ) underwent TDOAP were included. There were 39 males and 34 females with a mean age of 19.6 years (range: 3 - 60). Among them, 27 patients were recurrence cases and 30 cases were accompanied with micrognathia and obstructive sleep apnea-hypopnea syndrome (OSAHS). The mean preoperative degree of mouth opening was 6.6 mm (range: 1 - 20). After a release of ankylosis, a transport disc was performed and fixed to ramus with a distractor. Distraction began at Days 4 - 8 postoperation. The distraction rhythm and rate were 0.25 mm four times daily. Distraction stopped when planning distance was achieved. And a distractor was maintained in place for 3-6 months after completion of distraction and then removed. Active postoperative training of mouth opening was implemented. RESULTS: The mean distance of distraction was 15.3 mm (range: 12 - 23). The range of mouth opening of 65 patients increased to normal and bone formation in gaps were perfect. The mean follow-up period was 44.8 months (range: 18 - 102). Eight cases were recurrent. And 1/37 over 15 years old and 7/36 under 15 years old had recurrence. CONCLUSIONS: TDOAP is an effective treatment for TMJ ankylosis. A pediatric patient, especially recurrent, should be operated after adolescence to decrease recurrence. Micrognathia and OSAHS should be also considered during the treatment of ankylosis.

[Subjective outcomes after modified maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome].

OBJECTIVE: To evaluate subjective outcomes after modified maxillomandibular advancement(MMMA) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: In the study, 15 patients underwent MMMA for the treatment of OSAHS and received presurgical and postsurgical polysomnography. A questionnaire was done pre- and postoperatively. The questionnaire included the Epworth sleepiness scale (ESS), snoring, witnessed apneas, CPAP use, and satisfaction of the treatment. RESULTS: The preoperative polysomnography results of the patients were as follows: apnea-hypopnea index, 40.5±12.8 per hour; lowest oxygen saturation, 73.0%±7.4%; the postoperative polysomnography results were as follows: apnea-hypopnea index, 6.5±3.5 per hour; lowest oxygen saturation, 90.8%±2.1%.Preoperatively, the mean ESS score of the patients was 17.6. Postoperatively, the mean ESS score decreased to 4.3. CPAP was in nine patients before surgery and postoperatively no patients continued. All the patients were satisfied with the treatment and wanted to recommend the treatment to other patients with OSAHS. CONCLUSION: The review demonstrated that AHI,LSAT,EDS,snoring and witnessed apneas were improved greatly after MMMA technique for the treatment of OSAHS.

[Comparative analysis of two surgical techniques for controlling nasal width after Le Fort I osteotomy].

OBJECTIVE: To compare the efficacy of two surgical techniques for controllong nasal width after Le Fort I osteotomy. METHODS: Fifty-five patients who received the Le Fort I osteotomy have been included in this study. They were randomly divided into 2 groups. The experimental group received extraoral ABS, and the control group received traditional intraoral ABS. 3D photos of the patient's face were taken before operation and at postoperative 3 months. Alar width was measured on the 3D photos. Data was reported as means and standard deviations, and statistic analysis was done by using student t test. RESULTS: Compared with presurgical data, G. lat-G. lat increased by (2.66 +/- 1.47) mm, Al-Al increased by (2.20 +/- 1.22) mm and Sbal-Sbal increased by (1.30 +/- 1.33) mm in experimental group. G. lat-G. lat increased by (1.38 +/- 1.29) mm, Al-Al increased by (1.06 +/- 0.95) mm and Sbal-Sbal increased by (0.36 +/- 1.33) mm in the control group. There was significant difference between two groups. CONCLUSIONS: The surgical technique of ABS is the most important factor for determining the postoperative alar width. Both techniques have better effect on the Sbal-Sbal width control than the G. lat-G. lat and Al-Al width control. Traditional intraoral ABS can more effectively control the alar width. Both techniques cannot completely control the alar base widening after Le Fort I osteotomy.

[Preliminary study of condylectomy via intraoral approach].

OBJECTIVE: Condylectomy was performed to treat condylar osteoma or hyperplasia. Introduced two methods of condylectomy via intraoral approach and evaluated their clinical results. METHODS: Thirty-five patients, aging from 22 to 57.21 years, were treated by condylectomy via intraoral approach, of which 21 were condyle osteoma, 14 hemimandibular hyperplasia and condylar hyperplasia. Intraoral vertical ramus osteotomy (IVRO) were used in 32 patients and intraoral condylectomy via coronoid process resection was used in 3 patients. RESULTS: The treatment results including oral function and facial symmetry after the operation were good in all patients. The temporomandibular joint (TMJ) dysfunction syndrome alleviated or disappeared. The follow-up period was 6 months to 3 years, and no relapse of condylar osteoma or hyperplasia was found. The patients who had IVRO and TMJ reconstruction had some degree of transplanted bone resorption, and one patients had relapse of facial deformity. But the patients who had intraoral condylectomy via coronoid process resection only had mild condyle remodeling and no obvious bone resorption was noted. CONCLUSIONS: The two methods of intraoral condylectomy introduced in this stugy can successfully correct the facial deformity and TMJ dysfunction caused by condylar osteoma or hyperplasia. But the surgeons need to have excellent surgical skills and careful selection of the indications.

[The treatment of mandibular micrognathia secondary to temporomandibular joint ankylosis with distraction osteogenesis].

OBJECTIVE: To evaluate the clinical effect of distraction osteogenesis for patients with mandibular micrognathia secondary to temporomandibular joint (TMJ) ankylosis. METHODS: 43 patients (aged from 2 to 61 years old) with mandibular micrognathia were treated with mandibular distraction osteogenesis. Two types of mechanical distraction were utilized in this study. Ten patients (age ranged from 2 to 16-years-old, mean age 7.6 years old) with severe micrognathia underwent bilateral mandibular distraction with rigid external distraction (RED) device. Other 33 patients were treated with unilateral(6 cases) or bilateral (27 cases) mandibular distraction using internal distraction device. Distraction was started on the 4th to 8th day after operation and distraction rate was 0.25 mm every time, four times a day. Distractor was removed after 3 to 6 months of consolidation period. RESULTS: Eighty sides of mandible in 43 patients were lengthened. The mean distraction distance was 23.2 mm (ranged from 14 to 35 mm). After distraction, the average posterior airway space (PAS) was enlarged from 4.9 mm to 10.4 mm and average angle of sella-nasion-point B (SNB) was increased from 64.2 degrees to 74.5 degrees. The apnea hypopnea index (AHI) was decrease significantly. The profile was improved and OSA was improved effectively in each patient. No complication occurred during treatment. No persistent numbness of lower lip was observed. All patients were satisfied with the results. After a mean follow-up period of 20.3 months(5 to 103 months) , the result was stable and no obvious relapse of micrognathia was observed. CONCLUSIONS: Distraction osteogenesis is an effective way in correction of mandibular micrognathia secondary to TMJ ankylosis. RED is a new method for treatment of children and adolescence with severe mandibular micrognathia. The procedure is simple and safe with stable result.

[Novel RPGR gene mutation in a Chinese family with X-linked recessive retinitis pigmentosa].

OBJECTIVE: To screen the mutation in the RPGR gene in a large Chinese family with X-linked recessive retinitis pigmentosa (RP) and to describe the phenotype in affected males and female carriers. METHODS: Ophthalmic examinations were performed in 77 family members of a RP pedigree to identify affected individuals. Polymerase chain reaction (PCR) and direct sequencing were used for screening of mutations in RPGR gene exon ORF15. RESULTS: Mutation screening demonstrated a novel mutation, g.ORF15 + 577_578delAG, which caused an open reading frameshift and resulted in premature truncation of the RPGR protein. This mutation was detected in 8 affected male individuals and 14 obligate female carriers in this family and was found to segregate with the phenotype in this family. This mutation led to a severe RP phenotype in male affected individuals with some variability in the age of onset of night blindness and loss of visual acuity, but was recessive in female carriers without a RP phenotype. However the most striking phenotypic feature in female carriers in this pedigree was moderate to high myopia with refractive error ranging from -5.00 D to -22.00 D in 14 female carriers. CONCLUSIONS: This novel mutation in RPGR ORF15 causes serious RP phenotype in males and no RP phenotype in female carriers. Moderate to high myopia was a particular feature for female carriers in this pedigree. Our finding expands the spectrum of RPGR mutations causing RP and phenotypic spectrum of the disease in Chinese family, which is useful for further genetic consultation and genetic diagnosis.