Exploring the Use of Animal Models in Craniofacial Regenerative Medicine: A Narrative Review.

The craniofacial region contains skin, bones, cartilage, the temporomandibular joint (TMJ), teeth, periodontal tissues, mucosa, salivary glands, muscles, nerves, and blood vessels. Applying tissue engineering therapeutically helps replace lost tissues after trauma or cancer. Despite recent advances, it remains essential to standardize and validate the most appropriate animal models to effectively translate preclinical data to clinical situations. Therefore, this review focused on applying various animal models in craniofacial tissue engineering and regeneration. This research was based on PubMed, Scopus, and Google Scholar data available until January 2023. This study included only English-language publications describing animal models' application in craniofacial tissue engineering (in vivo and review studies). Study selection was based on evaluating titles, abstracts, and full texts. The total number of initial studies was 6454. Following the screening process, 295 articles remained on the final list. Numerous in vivo studies have shown that small and large animal models can benefit clinical conditions by assessing the efficacy and safety of new therapeutic interventions, devices, and biomaterials in animals with similar diseases/defects to humans. Different species' anatomical, physiologic, and biological features must be considered in developing innovative, reproducible, and discriminative experimental models to select an appropriate animal model for a specific tissue defect. As a result, understanding the parallels between human and veterinary medicine can benefit both fields.

A novel de novo variant in the PHF21A causes craniofacial abnormalities, intellectual disability and skeletal manifestations.

IDDBCS is a heterogeneous genetic syndrome with diverse clinical features including Intellectual disability and epilepsy. Using WES, Sanger sequencing, we identified a novel nonsense variant in the PHF21A gene responsible for IDDBCS syndrome. The patient has diverse and overlapping clinical phenotypes. The identified variant leads to abnormal secondary and tertiary structure of the protein and, consequently, affects its function.

Tessier number 7 cleft with unilateral complete cleft lip and palate: a case report.

To date, there have been no reports of patients showing a Tessier number 7 cleft with unilateral complete cleft lip and palate. Furthermore, no studies have established the sequence, plan, or timing of surgical methods for treating patients presenting the above anomalies simultaneously. We report a case of a Tessier number 7 cleft with unilateral complete cleft lip and palate. Two months after birth, lip adhesion was performed on the unilateral complete cleft lip and total excision was performed on the skin tag. At 4 months of age, Tessier number 7 cleft was corrected. At 6 months of age, surgery involving two small triangular flaps was performed on the unilateral incomplete cleft lip after performing lip adhesion. At 13 months of age, two-flap palatoplasty with a vomer flap was performed on the complete cleft palate. At 6 years of age, open rhinoplasty was performed on the unilateral cleft lip nose deformity. At 9 years of age, bone grafting was performed for the alveolar cleft. At follow-up appointments up to 13 years of age, there were no major complications. Here, we present this patient, surgical procedures and timelines, and show our results demonstrating good postoperative outcomes.

Recurrent Ptosis in a Case of Dubowitz Syndrome.

Dubowitz syndrome is a relatively rare genetic and developmental disorder. An eight-year-old female presented with a complaint of drooping in her left eye since birth. She had undergone ptosis surgery two years back. There was a history of delayed speech and delayed dentition. She was of moderate built appropriate to her age. There was microcephaly, sparse hair, flat bridge of the nose with a prominent rounded tip, short stature, low-set ears, and micrognathia with subsequent protrusion of upper two incisors. Based on the clinical features a diagnosis of Dubowitz syndrome with left recurrent ptosis was made. She underwent frontalis sling surgery and had a satisfactory outcome.

Unilateral Tessier 7 cleft: Case report of Z-plasty with geometric broken line repair and literature review.

Tessier 7 clefts are a rare congenital anomaly, usually surgically repaired with Z-plasty or other reconstructive methods, although undesirable scars may result. We present a review of the literature and a case of unilateral Tessier 7 cleft repaired with a novel reconstruction technique using a combined Z-plasty and geometric broken line closure (GBLC) to camouflage and irregularize the otherwise linear scar. We present this case to expand the armamentarium of surgical options to address Tessier 7 clefts and to review techniques for repair.

Genetic background influences the capacity for medial edge epithelium disintegration and phenotype of cleft palate in TGFß3 knockout mice.

OBJECTIVES: Cleft palate is a frequent congenital craniofacial malformation of unknown etiology. Transforming growth factor (TGF) ß3 is required for palatal shelf fusion. Although TGFß3 knockout (KO) mice are widely used mouse models for cleft palate, cleft palate phenotypes differ among these mice. This study aimed to determine the effects of genetic background on the cleft palate phenotype in mice. METHODS: We produced TGFß3 KO congenic mouse strains with five different genetic backgrounds. The phenotypes of the congenic strains were determined by visual examination. The capacity for disintegration of the medial edge epithelium (MEE) and basement membrane (BM) of palatal shelves of all five mouse strains was analyzed by using immunofluorescence staining after single palatal shelf suspension culture. The relationship between phenotype and disappearance of the MEE and BM was analyzed. RESULTS: Although the five congenic strains carried the same defective Tgfb3 gene, the fetal palate phenotypes differed among strains. The loss of the MEE cells and BM also differed with the genetic background, and the degree of such loss correlated with the cleft palate phenotype. CONCLUSIONS: The cleft palate phenotype in mice is influenced by the genetic background, which governs the capacity for MEE and BM disintegration.

Radiological diagnostic features of uremic leontiasis ossea: a case report.

Uremic leontiasis ossea (ULO), which occurs in the craniomaxillofacial region, is a sign of terminal stage osteitis fibrosa cystica or brown tumors and primarily caused by secondary hyperparathyroidism induced by renal failure. Pathophysiological changes include osteoclasts or osteoblasts proliferation, bone resorption, bone decalcification, and connective tissue proliferation. In this paper, we report a case of a 24-year-old female patient, who was diagnosed with ULO and presented with multiple facial swellings. Imaging features included zonal patterns with alternating rings of hypo- and hyperattenuated craniomaxillofacial bones, and diffused mixed sclerotic tissues with lytic changes in CT imaging. T1 weighted image and T2 weighted image in MRI were characterized by alternating rings of low and intermediate signal intensity patterns. To the best of our knowledge, this case is the first example of pathologically proved ULO with maxillofacial MRI.

Soft tissue reconstruction in wide Tessier number 3 cleft using the straight-line advanced release technique.

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.

Soft tissue reconstruction in wide Tessier number 3 cleft using the straight-line advanced release technique

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.

Neonatal hyperinsulinemic hypoglycemia in a patient with 9p deletion syndrome.

We report the clinical and neuroradiological findings in a young boy harboring the 9p deletion syndrome including the novel findings of thalamic infarction and germinal matrix haemorrhage and neonatal hyperinsulinemic hypoglycemia. Both the hypoglycemic events and the ventriculomegaly found in this patient have previously only been reported in two patients, while the thalamic infarction and germinal matrix haemorrhage are novel features.

The 50 Most Cited Papers in Craniofacial Anomalies and Craniofacial Surgery.

BACKGROUND: Citation analysis is a recognized scientometric method of classifying cited articles according to the frequency of which they have been referenced. The total number of citations an article receives is considered to reflect it's significance among it's peers. METHODS: Until now, a bibliometric analysis has never been performed in the specialty of craniofacial anomalies and craniofacial surgery. This citation analysis generates an extensive list of the 50 most influential papers in this developing field. Journals specializing in craniofacial surgery, maxillofacial surgery, plastic surgery, neurosurgery, genetics and pediatrics were searched to demonstrate which articles have cultivated the specialty within the past 55 years. RESULTS: The results show an intriguing compilation of papers which outline the fundamental knowledge of craniofacial anomalies and the developments of surgical techniques to manage these patients. CONCLUSIONS: This citation analysis provides a summation of the current most popular trends in craniofacial literature. These esteemed papers aid to direct our decision making today within this specialty.

The 50 Most Cited Papers in Craniofacial Anomalies and Craniofacial Surgery

BACKGROUND: Citation analysis is a recognized scientometric method of classifying cited articles according to the frequency of which they have been referenced. The total number of citations an article receives is considered to reflect it's significance among it's peers. METHODS: Until now, a bibliometric analysis has never been performed in the specialty of craniofacial anomalies and craniofacial surgery. This citation analysis generates an extensive list of the 50 most influential papers in this developing field. Journals specializing in craniofacial surgery, maxillofacial surgery, plastic surgery, neurosurgery, genetics and pediatrics were searched to demonstrate which articles have cultivated the specialty within the past 55 years. RESULTS: The results show an intriguing compilation of papers which outline the fundamental knowledge of craniofacial anomalies and the developments of surgical techniques to manage these patients. CONCLUSIONS: This citation analysis provides a summation of the current most popular trends in craniofacial literature. These esteemed papers aid to direct our decision making today within this specialty.

Cranial neural crest cell contribution to craniofacial formation, pathology, and future directions in tissue engineering.

This review provides an overview of the state and future directions of development and pathology in the craniofacial complex in the context of Cranial Neural Crest Cells (CNCC). CNCC are a multipotent cell population that is largely responsible for forming the vertebrate head. We focus on findings that have increased the knowledge of gene regulatory networks and molecular mechanisms governing CNCC migration and the participation of these cells in tissue formation. Pathology due to aberrant migration or cell death of CNCC, termed neurocristopathies, is discussed in addition to craniosynostoses. Finally, we discuss tissue engineering applications that take advantage of recent advancements in genome editing and the multipotent nature of CNCC. These applications have relevance to treating diseases due directly to the failure of CNCC, and also in restoring tissues lost due to a variety of reasons.

The gold standard of dental care: the juvenile horse.

Postpartum evaluation of the foal's head and mouth are performed to detect craniofacial malformations and other congenital defects. Detailed oral examination and diagnostic imaging can provide diagnostic and prognostic information about congenital abnormalities of the mouth or skull. Important abnormalities of foals include wry nose, cleft palate, overbite (parrot mouth), and underbite (monkey mouth, sow mouth). Tumors and cysts can be detected in young horses. In juvenile horses, primary dental care procedures include oral examination, management of sharp enamel points, management of deciduous teeth, and management of wolf teeth. Facial or jaw swellings are also important considerations.

Giant hemangioma presenting as a scalp mass leading to a craniofacial deformity.

Hemangioma is the most common vascular tumor during childhood. However, cases of giant hemangiomas determining deformities in the craniofacial region are not reported frequently. Craniofacial giant hemangiomas are challenging for surgeons since they cause aesthetic and/or functional problems and may be associated with important complications such as ulcerations, infections and bleedings. The present report is aimed at describing a rare case of craniofacial asymmetry in a 30-year-old patient, secondary to an extensive mass whose growth deformed the scalp in the frontal-parietal-temporal region. The lesion was completely surgically removed with good aesthetic results, and the anatomopathological examination revealed that it was a cavernous hemangioma.

Prevalencia y caracterización de los recién nacidos con anomalías craneofaciales en el Instituto Materno Infantil de Bogotá / Prevalence and characterisation of the newborn suffering craniofacial anomalies at the Instituto Materno Infantil in Bogotá

Objetivos Determinar la frecuencia y caracterizar los neonatos nacidos con anomalías craneofaciales atendidos en el Instituto Materno Infantil (IMI). Métodos Se recolectaron los datos de nacidos o remitidos al IMI, estrato, procedencia, factores de riesgo general y específico, género, edad gestacional, correlación peso y edad gestacional, diagnóstico de la anomalía, cariotipo y condición al egreso de los neonatos con anomalías craneofaciales atendidos entre 1 de Marzo de 2000 y 15 de Agosto de 2001. Resultados La prevalencia de anomalía congénita fue 2,7 por ciento y de anomalía craneofacial 0,6 por ciento. De 52 pacientes, 69 por ciento tenía factores de riesgo específico, 38 por ciento era prematuro y 33 por ciento tenía retardo del crecimiento intrauterino; 65 por ciento correspondió a hendiduras, 55,8 por ciento a anomalía múltiple y 46 por ciento a síndromes. Se estableció diagnóstico etiológico en 38 por ciento de los casos; 12 por ciento tenía cromosomopatía. Fallecieron 18 niños (35 por ciento) y en 13 la muerte se atribuyó a la anomalía, 6 de éstos tenían cromosomopatía. Se evidenció la utilidad del cariotipo para hacer diagnóstico etiológico y establecer pronóstico. Los neonatos con anomalías craneofaciales tuvieron 3 veces más riesgo de morir que el resto de neonatos hospitalizados. Se demostró asociación estadísticamente significativa de la mortalidad con prematurez, retardo de crecimiento, cromosomopatía y diagnósticos de anomalía múltiple y síndrome. Conclusiones Prematurez, retardo de crecimiento, anomalía múltiple, diagnóstico de síndrome y cromosomopatía evidencian un perfil de riesgo para mortalidad.

Objectives Determining the frequency and characteristics of newborn suffering craniofacial abnormalities who were attending the Instituto Materno Infantil (IMI) in Bogotá. Methods Data was gathered regarding the newborn suffering such alterations who attended IMI from March 1 st 2000 to August 15 th 2001. The variables analysed were: being born in or having been remitted to the IMI, social strata, origin, general and specific risk factors, gender, correlation between weight and gestational age, clinical and aetiological diagnosis of the anomaly, karyotype and condition on leaving IMI. Results There was 2,7 percent prevalence for congenital defects and 0,6 percent for craniofacial abnormalities. 69 percent of the 52 patients had specific risk factors, 38 percent had been preterm, 33 percent had suffered retarded intra-uterine growth, 65 percent had cleft palates, 55,8 percent multiple abnormalities and 46 percent syndromes. Aetiological diagnosis was established in 38 percent; 12 percent had chromosomopathy. Eighteen children (35 percent) died, death being attributed to their defect in 13 of them, six by chromosomopathy. This study revealed the use of karyotype in making an aetiological diagnosis and determining prognosis. Mortality for the group suffering craniofacial abnormalities was threefold that of other hospitalised neonatal patients. Significant statistical association was shown between mortality and preterm condition, retarded growth, chromosomopathy and a diagnosis of multiple defects and/or syndromes. Conclusions Prematurity, retarded growth, multiple defects, syndrome diagnosis and chromosomopathy revealed a mortality risk profile.

An Experience of Anesthesia of Congenital Anomaly with Airway Involvement : 46 case report

As the improved medical techniques and environmental changes have increased the frequency of general anesthesia for uncommon congenital anomalies. The airway management for a patient with congenital anomaly gives significant challenges to the anesthesiologist. The purpose of this report is to review the authors' experience with airway management and ventilatory support during the perioperative period in children with congenital anomalies with airway involvement, and to summarize anesthetic implications associated with particular congenital anomalies by literature review. Total 46 cases of general anesthesia for operation of congenital anomalies were performed from January 2000 to August 2005 in our hospital. Most common congenital anomaly is a Down syndrome (17 cases, 37%), and most common cause of surgery is the orthopedic surgery for correction of deformed spine (18 cases, 41%). Direct laryngoscopy was successfully used to establish an airway in 35 (76.1%) cases, whereas 5 (11%) cases required the use of fiberoptic bronchoscopy to establish an airway before surgery.