Outcomes of alveolar cleft repair in complete cleft lip and palate after tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy.

OBJECTIVES: Gingivoperiosteoplasty is often used for reconstruction of alveolar defects in infants with cleft lip and palate. This study aimed to examine outcomes of tertiary gingivoperiosteoplasty, which has not previously been investigated. MATERIALS AND METHODS: This prospective study included 11 adults with complete cleft lip and palate (n = 12 sites) who consecutively underwent segmental Le Fort I osteotomy and concomitant gingivoperiosteoplasty for correction of skeletal class III deformity, nasoalveolar fistula and alveolar cleft. Outcomes included clinical and radiographic evaluations of gingivoperiosteoplasty at the time of osteotomy (presence of nasoalveolar fistula, residual cleft defect and unsupported root ratio of cleft-adjacent teeth), and determination of influencing factors for the clinical success of alveolar cleft repair. Study variables included age, gender, pre-surgical orthodontic treatment and alveolar cleft width of cleft-adjacent canine and angulation between cleft-adjacent teeth before surgery and 1-week postsurgery. RESULTS: Posttreatment, no nasoalveolar fistula remained. The residual cleft defect decreased significantly (p < 0.01). The unsupported root ratio of cleft-adjacent teeth did not differ (p > 0.05); eight cleft sites reached Bergland I or II (67% success). One-week postsurgery, the minimal alveolar cleft width of cleft-adjacent canine was significantly less in the success group compared with the failed group (p = 0.01). CONCLUSIONS: Tertiary gingivoperiosteoplasty and segmental Le Fort I osteotomy decreased nasoalveolar fistulas and induced alveolar bone formation. The minimal alveolar cleft width immediately after surgery was the major influencing factor of clinical success. CLINICAL RELEVANCE: Segmental Le Fort I osteotomy with simultaneous gingivoperiosteoplasty efficaciously repairs adult alveolar clefts.

Simultaneous Orthognathic Surgery With Asian Double Eyelid Suture Blepharoplasty.

BACKGROUND: The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting. METHOD: This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze. RESULTS: There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained. CONCLUSIONS: Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.

Photon recycling characteristics of InGaAs/GaAsP multiple quantum well solar cells incorporating a spectrally selective filter and distributed Bragg reflector.

Photon management plays a vital role in the power conversion efficiency of III-V semiconductor solar cells. However, the photon recycling characteristics of GaAs-based multi-quantum-well (MQW) solar cells employed different optical designs had yet been fully explored. In this work, we investigate the impact of the spectrally selective filter (SSF) and distributed Bragg reflector (DBR) on the photovoltaic characteristics of single-junction, strain-balanced In0.1Ga0.9As/ GaAs0.85P0.15 MQW solar cells. Specifically, the SSFs with cutoff wavelengths of 880, 910, and 940 nm are designed and implemented on MQW solar cells with and without the incorporation of a rear DBR. Photon confinement in the vertical direction is verified based on the characterizations of reflectance, electroluminescence, and external quantum efficiency. We show that the photon confinement reduces the saturation current density, up to 26 times and 3 times for the 880 nm SSF-MQW and SSF-MQW-DBR devices, respectively, compared to that of the 940 nm devices. Furthermore, by comparing the SSF-MQW-DBR solar cells under simulated one-sun and concentrated illumination conditions, the open-circuit voltage exhibits a maximal net increase for the 910 nm SSF due to tradeoff between the short-circuit and saturation current density. The proposed SSF design may offer a viable approach to boost the performance of GaAs-based MQW solar cells.

3D-TEM study on the novel bicontinuous microdomain structure.

An ordered bicontinuous double-diamond (OBDD) morphology was found in polystyrene-block-(poly-4-vinylphenyldimethylvinylsilane-graft-polyisoprene), PS-b-(PVS-g-PI), block-graft copolymer. We obtained a 3D image of the microdomain structure formed in PS-b-(PVS-g-PI) using 3D-TEM. The 3D image shows that the polystyrene (PS) phase consists of two independent and interwoven networks. The structures of the two networks are identical and include tetrapod units that form planar six-membered rings. The features of the networks agree with those in the OBDD morphology, indicating that PS-b-(PVS-g-PI) exhibits ordered three-dimensional OBDD networks with the PS phase in the polyisoprene (PI) matrix phase. The grafted PI chains induce the frustration of the PS chains; thus, the effects of the specific interface are more dominant than those of packing frustration in the formation of the morphology, and the OBDD phase is stabilized.

Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study.

Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.

Comparative Outcomes of Primary Gingivoperiosteoplasty and Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate.

BACKGROUND: The role of primary gingivoperiosteoplasty in the repair of alveolar clefts remains controversial. The aim of this study was to compare the outcomes of primary gingivoperiosteoplasty and secondary alveolar bone grafting in patients with unilateral cleft lip and palate. METHODS: In this prospective study, the authors analyzed the postoperative cone-beam computed tomographic scans of 50 children with complete unilateral cleft lip and palate who underwent primary gingivoperiosteoplasty (n = 25) or secondary alveolar bone grafting (n = 25). These two methods of alveolar repair were compared by measuring residual cleft defect and unsupported root ratio of cleft-adjacent central incisors on patient scans. RESULTS: Patients who underwent repair by primary gingivoperiosteoplasty presented more need for additional bone grafting than those undergoing repair by secondary alveolar bone grafting (28 percent versus 4 percent, respectively; p < 0.05). Residual cleft defect was greater in patients who underwent repair by primary gingivoperiosteoplasty than by secondary alveolar bone grafting (305.8 ± 176.5 mm versus 178.6 ± 122.0 mm, respectively; p < 0.05). Patients who underwent repair by primary gingivoperiosteoplasty showed more residual palatal coronal and palatal apical defects than those who underwent repair by secondary alveolar bone grafting (p < 0.05 and p < 0.001, respectively). CONCLUSIONS: In patients with unilateral cleft lip and palate, primary gingivoperiosteoplasty can achieve 72 percent success. Primary gingivoperiosteoplasty results in less bone than secondary alveolar bone grafting, particularly on the palatal apical portion of the previous alveolar cleft. Clinical success is lower with primary gingivoperiosteoplasty than with secondary alveolar bone grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Comparative outcomes of two nasoalveolar molding techniques for bilateral cleft nose deformity.

BACKGROUND: Bilateral cleft nose deformity is increasingly being treated before primary repair with nasoalveolar molding. With the Grayson technique, nasal molding is started when the alveolar gap is reduced to 5 mm, whereas with the Figueroa technique, nasal molding and alveolar molding are performed at the same time. Both techniques significantly lengthen the columella, but their comparative efficacy, efficiency, and incidence of complications have not been investigated. METHODS: In this blinded, retrospective study of 58 patients with complete bilateral cleft lip-cleft palate, 27 underwent Grayson nasoalveolar molding and 31 underwent Figueroa nasoalveolar molding. Outcomes were compared by analyzing pretreatment and posttreatment facial photographs and clinical charts for efficacy (i.e., columella length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, and nasal base angle), efficiency (i.e., molding frequency), and incidence of complications (e.g., facial irritation and oral mucosal ulceration). RESULTS: Grayson and Figueroa nasoalveolar molding did not differ in treatment efficacy for columellar length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, or nasal base angle (all p > 0.05). Grayson nasoalveolar molding was less efficient (i.e., required more adjustments) (10.8 ± 4.1 versus 7.6 ± 1.5; p = 0.001) and had a higher incidence of oral mucosal ulceration (26 percent versus 3 percent; p < 0.05). CONCLUSIONS: Both Grayson and Figueroa nasoalveolar molding similarly improve nasal deformities and reduce alveolar gaps; however, the Figueroa technique is associated with fewer oral mucosal complications and more efficiency.

Outcome of gingivoperiosteoplasty for the treatment of alveolar clefts in patients with unilateral cleft lip and palate.

Gingivoperiosteoplasty (GPP) has produced inconsistent outcomes. The purpose of this prospective study was to investigate the effects of GPP on the production of bone and maxillary growth. We analysed postoperative cone-beam computed tomographic (CT) scans and intraoral dental photographs of 25 children with complete unilateral cleft lip and palate (UCLP) who were treated with GPP at the same time as their primary repair of the lip. Residual cleft defects and unsupported root ratios of central incisors adjacent to clefts were measured from scans. Dental arch relations were assessed from photographs using the Goslon (Great Ormond Street London and Oslo) yardstick. Eighteen children did not require secondary alveolar bone grafts. Residual cleft defects varied by site (20.4mm(3), 38.6mm(3), 88.2mm(3), and 135.2mm(3) for buccal coronal, palatal coronal, buccal apical, and palatal apical defects, respectively; p<0.001). Unsupported root ratios did not differ significantly between coronal and apical central incisors adjacent to clefts. The mean (SD) Goslon score was 4.52 (0.51). Most participants (n=18) who had a GPP did not need secondary alveolar bone grafting. GPP resulted in least bone on the palatal apical portion of the previous alveolar cleft and relatively good periodontal bony support of central incisors adjacent to the cleft. We no longer use GPP because of our concerns about maxillary growth.

Genial tubercle position and dimensions by cone-beam computerized tomography in a Taiwanese sample.

OBJECTIVE: . The aim of this study was to evaluate the position and dimensions of the genial tubercle in a Taiwanese sample. STUDY DESIGN: Cone-beam computerized tomography (CT) records of 90 adult patients with class I or class II skeletal type were used to evaluate the position and dimensions of the genial tubercle and dimensions of the anterior mandible. Subjects were grouped by sex and skeletal type. RESULTS: In all groups, the genial tubercle height was close to the genial tubercle width. The distance from the inferior border of the genial tubercle to the inferior border of the mandible was greater in class II male patients than in class I female patients (P < .05). The anterior mandible in class I male patients was thicker than in class II female patients (P < .05). CONCLUSIONS: The variable position and dimensions of this structure among patients suggest the need for cone-beam CT before attempting genioglossus advancement to treat obstructive sleep apnea.

Critical analysis of the crystal orientation behavior in polyethylene-based crystalline-amorphous diblock copolymer.

Orientation of polyethylene (PE) crystals formed over a broad range of undercooling in a polyethylene-block-poly(D,L-lactide) (PE-b-PDLLA) diblock copolymer has been critically examined. Due to the large segregation strength and approximate 50/50 composition in this system, the crystallization took place within one-dimensionally confined lamellar microdomains without forming spherulites. A homogeneous crystal orientation with the PE crystalline stems orienting parallel to the lamellar interface was observed at crystallization temperatures (T(c)) between 45 and 102 °C. Once the sample was crystallized at T(c) ≤ 40 °C or directly quenched into liquid nitrogen from the melt, the isotropic WAXD pattern indicated that the PE crystals became randomly oriented. Considering that homeotropic orientation was not identified for the present system and other PE-based crystalline-amorphous diblocks, we concluded that PE crystals in the lamellar microdomains always show homogeneous orientation when there is a preferred orientational order. We further organized the thermodynamic and kinetic factors that may govern the preferred crystal orientation in diblock copolymers and concluded that the orientational order should be controlled by the competition between nucleation and crystal growth kinetics. The persistence of homogeneous orientation of PE was attributed to its excellent nucleating power.