Clinical Analysis of the Cleft Patterns of Lip and Palate

The patterns in the cleft lip and palate were classified in great detail, and the point of center of the clefts in this disease was speculated. The purpose of the present study was to establish the basic data for classifications of epidemiological surveys in the future. The subjects were 377 patients with cleft lips and palates who visited the Second Department of Oro-Maxillo-Facial Surgery, Aichi-Gakuin University Hospital. The models of cleft lip and palate divided into 17 segments prepared for an analysis of cleft patterns. And as consequence, the following results were obtained.     

A Review of Unilateral Cleft Lip and Palate Surgery*

ABSTRACT Operative techniques for unilateral cleft lip and palate have undergone continuous development, with improvement and modification, during the last three decades. The author's operation began with Tennison's method and gradually changed into a narrower and long triangular flap method. The edge of the orbicularis oris muscle on the cleft side is tucked under the center of the philtral dimple to obtain muscles linkage and a philtral ridge on the affected side. The longitudinal line is sutured with meticulous subcuticular stitches using 6–0 Nylon, resulting in a neat scar. Relationship between vertical height of lip and width of triangular flap was examined in follow-up studies. Flap width increased rapidly for one year after surgery and then slowed down to a pace proportionate with lip height. Although ratio of flap width to height increased from 27% to 40%, the balance of both sides of the lip did not, as had been thought might be possible, change. Correction of the cleft lip nose by the triangular flap method is rather difficult. It is considered natural for many surgeons to prefer a combination of the rotation-advancement flap and small triangular flap. Much remains to be discussed regarding cleft palate treatment. Author prefers closure of the hard palate using a vomer flap in the primary cleft lip operation because the most effective push-back of the palate, without fistulae, is achieved. Underdevelopment of lip and maxilla should be evaluated from many aspects, and with a long-term view.     

Epidemiological Approaches to Identify Risk Factors for Human Congenital Malformations: Descriptive and Analytical Epidemiology of Cleft Lip and/or Palate in Japan*

Abstract This paper described three major epidemiological approaches to explore etiological clues to and risk factors for human congenital malformations, taking cleft lip and/or palate as an example. (1) An analysis of mortality statistics demonstrated an apparently downward trend of infant mortality from cleft lip and/or palate over the recent three decades in Japan. This particular finding was found to be plausibly ascribable to changing clinical assignment of causes of death from “cleft lip and/or palate” to “congenital heart diseases” or “multiple anomalies, syndromes or chromosome abnormalities”, when previous reports on incidence rate and autopsy series were examined. (2) A case-control study of 194 infants with cleft lip and/or palate (cases) and 194 normal infants (controls), who were matched to cases for sex, maternal age to within one year, birth order and residential area, yielded the following major findings, (a) A significantly increased risk was associated with parental highest educational attainment of less than 19 years, parental occupation of unskilled/service workers, positive family history of cleft lip and/or palate, positive past history of artificial abortion, maternal smoking habits at first trimester, and maternal episodes at first trimester of suffering from any diseases and of ingesting any drugs, (b) A significantly decreased risk was linked with frequent maternal intake at first trimester of such animal proteins as meats, fishes and shells, eggs and milk, (c) Maternal drinking habits and radiation exposures, and frequent maternal ingestion of Japanese/black tea were not associated. (d) Maternal coffee drinking at first trimester significantly elevated the risk, but turned to be unrelated when maternal smoking habits were statistically corrected. (3) A cohort study of approximately 10,000 pregnants, which is ongoing from April 1989 in Nagoya and aims to disclose the associations of parental life-style habits with general pregnancy outcomes including major congenital malformations, was briefly discussed.     

A Study on the Growth and Development of the Cranial Base in the Japanese Unilateral Cleft Lip and Palate: Comparison with the Japanese Skeletal Class I Occlusion

Abstract The purpose of this study is to investigate the growth and the developmental dimension and the feature of cranial base transition in unilateral cleft lip and palate (UCLP). With regared to this proposition, we have already submitted a paper in which we compared our study with skeletal reversed occlusion on a scholary journal. The authors will present this proposition in comparison with skeletal class I. The subject group consisted of 15 males and 12 females with UCLP. The control group consisted of 11 males and 14 females with skeletal class I. Standared lateral cephalometric radiographs taken at first medical examination and three years later were used. The three linear dimensions (S-N, S-Ba, N-Ba) and craniobasal angle (N-S-Ba) were measured. The results were as follows: 1) Females showed no significant difference in S-N, S-Ba and N-Ba but males had smaller S-Ba and N-Ba in the UCLP as compared with the control at the first examination and 3 years later. 2) There were no significant difference in the three distance items, S-N, S-Ba, N-Ba, for females but significantly larger changes in N-Ba appeared in the UCLP as compared with the controls for males. 3) The cranial base angle (N-S-Ba) showed no significant difference between the UCLP and controls for both male and female subjects at any observation time. From the above evidences, it is estimated that the cranial base size and angle in the UCLP as compared with those of controls show no consistent trend owing to possible involvement of differential growth pattern between the anterior cranial base and posterior cranial base. The growth of cranial base itself per se seems to be influenced mutually at minimal level by the maxillofacial growth. This suggests growth patterns of cranial base and maxillofacial region are independent from each other.     

Prevalence of cleft lip and/or palate in children from Lodz between years 1981–2010

Congenital malformations constitute a serious problem of both medical and social nature. Cleft lip and/or palate represent the most common congenital anomaly of the face that is why it is essential to know the real frequency of the described phenomenon. The aim of this paper is to determine the frequency of cleft lip and/or palate and the types of malformations that occurred in Lodz city between the years 1981–2010. Our clinic has been carrying on the studies concerning the incidence of cleft lip and/or palate since 1981. The Polish Registry of Congenital Malformations has been operating in Poland since 1 April 1997. The team has managed to obtain data, from the Registry, concerning the total number of all live born infants and the number of children with cleft lip and/or palate, who were born in Lodz, between 1998 and 2010. In years 1981–2010, 319 children, in 210 952 live born infants, were born with cleft lip and/or palate in Lodz. The isolated cleft palate was observed more frequently in girls and the unilateral cleft of lip and palate in boys. In all three decades palate clefts are more common whereas bilateral lip, alveolus and palate clefts are more infrequent. A small tendency to decrease in actual cleft lip and/or palate frequency among children, in the period of 30 years, is observed in Lodz. Over the years it has still been observed that the isolated cleft palate is the most common type of defect.     

Surgical Procedure for the Cleft Hand: Especially in Relation to Restoration of Instinsic Muscle Function of the Shifted Index Finger*

ABSTRACT We have thirty-eight patients of cleft hand, and they were divided into three groups from the surgical point. Four patients (seven hands) has only one digit on the radial side of the cleft. In these patients there was little indication for the surgical improvement. The thumb and index finger are completely webbed in six patients (seven hands), and reconstruction to permint thumb function is essential above all in these. In most patients of cleft hand (thirty-one out of thirty-eight) thumb function is preserved, but abduction of the thumb was more or less limited. Surgical procedure for these patients are discussed. There are three important point in surgical reconstruction of the celft hand; First is a skin incision to restore thumb abduction; Second is a realignment of the second metacarpal (index ray); and Third is a restoration of intrinsic function. Regarding the first and second point we reported previously (Miura and Komada, 1979). Now, we would like to emphasis that intrinsic function act as a key to get satisfactory result in surgical procedure for the cleft hand. We could use the extrinsic extensor or flexor muscles of the missing middle finger as a proper force for restoration of intrinsic function. We were pleased to use the extrinsic extensor that is found in same incision for the translocation of the index ray. The extrinsic flexor in extrinsic extensor was used. The extrinsic extensor of the middle finger was abscent in one patient.     

Palatal Slit and Cleft Palate in Rats Treated with Glucocorticoids II. Comparative Teratogenicity of Prednisolone, Triamcinolone Acetonide and Hydrocortisone

The induction of abnormal palatal development by three glucocorticoids; prednisolone, triamcinolone acetonide and hydrocortisone was evaluated in rat fetuses. Pregnant rats were injected subcutaneously with either prednisolone (12.5-100 mg/kg/day), triamcinolone acetonide (0.25-2 mg/kg/day) or hydrocortisone (100 mg/kg/day) on days 14 and 15 of gestation. These females were humanely killed on day 20 of gestation and viable fetuses were inspected for their palatal abnormalities. The frequencies of cleft palate were significantly higher in the group treated with 100 mg/kg/day prednisolone (10.6%), and in the groups treated with 0.5, 1 and 2 mg/kg/day triamcinolone acetonide (8.6%, 26.1% and 58.3%, respectively) than the control frequency of 0%. Triamcinolone acetonide was 70 times as potent as prednisolone in inducing palatal slit, with ED₅₀ value of 1.0 mg/kg/day and 70 mg/kg/day, respectively. Hydrocortisone showed no potentiality for the induction of cleft palate and palatal slit. Other developmental abnormalities including omphalocele and general edema, late resorption, and growth retardation were induced by triamcinolone acetonide and prednisolone. These findings indicate that triamcinolone acetonide has a significantly higher potentiality for the induction of palatal slit in rats, as well as in mice, compared to prednisolone and hydrocortisone.     

A Clinical and Experimental Study on Longitudinal Deficiencies in Lower Limbs in Relation to Pathogenesis of Cleft Foot

Abstract In order to determine whether cleft foot is caused by the same mechanism as tibial and fibular ray deficiencies, clinical cases of these anomalies and those in rat fetuses induced by myleran were analyzed. In tibial and fibular ray deficiencies, arrest of tibia or fibula was closely related to the missing of toes and tibial and fibular ray deficiencies can be accepted as an occurrence of so called longitudinal deficiency. On the other hand, cleft feet were frequently associated with central Polydactyly and syndactyly. In our experimental study, the critical period of formation of cleft foot was different from that of tibial ray deficiency, but it was similar to those of central Polydactyly and syndactyly. It seems that cleft foot is caused by the abnormal induction of toe rays as in cleft hand and does not belong to the same group as tibial and fibular ray deficiencies.     

Prospects of the Reproductive Toxicology: With Special Reference to the Developmental Hazards Due to the Treatment at the Stages from Prefertilization to Implantation*

ABSTRACT With the definition of teratogenicity was expanded in terms of developmental stages when the agent acts and types of developmental anomalies induced, the concept of reproductive toxicity or developmental toxicity has been established. These new terms are essentially the synonym; the former gives the prime emphasis on the parent generation while the latter on the longer phase of developmental stage of the offspring. It has been generally stated that the environmental agents which act before the onset of organogenesis will bring the embryo either death or normal growth. However, some affect the preimplantation embryos with resultant congenital anomalies. Moreover, it has been demonstrated that various developmental defects can be induced by a premating treatment to males, some of which may have been caused by mechanisms other than mutagenicity. On the other hand, oogenesis in females takes a very long time and it is often difficult to determine when these environmental agents act before or after pregnancy. Recent episodes of herbicides (Agent Orange) and vaginal spermicides were introduced as examples. Pharmaceutical drugs, chemicals given to humans intentionally at a relatively large amount in a limited duration, have been requested to be tested in laboratory animals on the possible developmental defects in offspring even when given prior to organogenesis. In Japan, at the test administered prior to and in the early stages of pregnancy (segment I study), it is recommended not only to examine fertility of the parent generation but also to observe the development of offspring as long as practically possible. In the symposium held at the 24th Annual Meeting of the Japanese Teratology Society, significance of developmental failures of the offspring induced by environmental factors given to the parents and during the preimplantation period was critically discussed.     

上海市2022年3至5月新型冠状病毒疫情防控中复旦大学附属儿科医院新生儿人群实施气泡式管理的实践和效果

背景：上海市2022年3至5月新型冠状（新冠）病毒疫情（简称：本次疫情）中复旦大学附属儿科医院（我院）作为新生儿的定点收治医院，面对本次疫情的复杂性，对新生儿特殊人群，协调好疫情防控和医疗救治面临挑战。 目的在我院气泡管理总体策略中实施和完善新生儿中气泡的管理策略。设计：观察性研究。 方法：新生儿中气泡的院内管理中包括4个小气泡。（1）上海市公共卫生中心新冠病房（红色）小气泡，收治核酸或抗原阳性的新生儿，按照我院新冠病房管理原则进行管理。（2）隔离病房（橙色）小气泡，设置于我院内单独楼，收治高危流行病史新生儿，进入橙色小泡的新生儿均需完成7 d医学隔离和观察，其中的负压和非负压房间设置各自独立的物品放置点，工作人员分别为二级和一级防护（+4），物品和标本的运送由摆渡人完成；（3）过渡病房（黄色）小气泡，收治低危流行病史新生儿，每间隔24 h行核酸检测，连续3 d核酸阴性则结束医学观察，其中单间和多人间设置各自独立的物品放置点，工作人员分别为二级和一级防护（+4），物品和标本的运送由摆渡人完成；（4）清洁病房（绿色）小气泡，我院常规住院新生儿的诊疗区域，接收橙色和黄色小气泡确定无新冠感染风险的新生儿。新生儿转运统一由上海市120急救车及不同气泡转运团队护送转入，红色小泡的出泡按照我院新冠病房管理原则进行；橙色小泡出泡需同时满足：①新生儿完成7 d医学观察，②出院后所住家庭的楼栋无新冠阳性感染者，③居家照护者及同住人均为健康码绿码，或已解除隔离，④接新生儿出院家属为健康绿码及48 h内核酸阴性；黄色小泡出泡需满足：完成72 h医学观察。住院期间，医务人员通过微信与新生儿家长沟通，随时解决父母的疑惑、焦虑和困难。 主要结局指标：医护医辅人员职业暴露和医院感染。 结果：本次疫情期间我院共收治新生儿677例，其中158例（130例来自红色小泡，其他医疗机构转运21例，橙色小泡转运团队外出转运7例）进入橙色小泡，其中早产儿10例（6.4%）；519例新生儿（375例来自社区，黄色小泡转运团队外出转运144例）进入黄色小泡，其中早产儿173例（33.3%），需机械通气呼吸支持82例（15.8%），无创通气45例（8.7%），完成72 h医学观察后全部进入绿色小泡，其中NICU 137例，普通病房382例，平均住院时间为13.5 d。1例新生儿在橙色小泡诊断为复杂性先天性心脏病，在完成7 d医学观察后转入心脏ICU（CCU）。2例在橙色小泡期间核酸检测阳性（为生后与新冠阳性母亲有接触史）转入红色小泡。324名医护医辅人员参与红色、橙色、黄色和绿色小泡工作，均未发生职业暴露，未发生新冠病毒医院感染。 结论：本次疫情下实施新生儿气泡管理可行，防控职业暴露和医院感染效果好。