鼓室置管对婴儿期腭裂患者中耳功能障碍的治疗效果

目的比较鼓室置管和鼓膜穿刺术治疗婴儿期腭裂患儿分泌性中耳炎（SOM）的效果,探讨腭裂中耳功能障碍的最佳治疗方法和早期干预时机。方法19例患SOM伴听力损失的婴儿期腭裂患儿的38耳在唇裂修复术同期行鼓室置管术,平均置管年龄为6.9月龄;15例患SOM的婴儿期腭裂患儿30耳行鼓膜穿刺术,平均穿刺年龄为6.6月龄。术后1周至12个月内于每个月行听性脑干反应（ABR）和声导抗检查作为判断指标,比较两种手术的疗效。结果38耳鼓室置管术前ABR Ⅴ波平均阈值为55.41 dBnHL,术后1周～12个月的平均值为28.48 dBnHL,术后听力提高26.93 dBnHL。置管术后峰压点平均升高90.72 daPa,坡度：比值法升高0.01,压力范围法降低84.00 daPa,静态声顺值平均升高0.04 mL;B型鼓室图（24耳）转化为A型者19耳,转化率为79.17%。30耳鼓膜穿刺术前ABR Ⅴ波平均阈值为40.63 dBnHL,术后1周为26.50 dBnHL,听力提高14.13 dBnHL。穿刺后1周B型鼓室图（22耳）转化为A型者9耳,转化率为40.91%;穿刺后1月和3月ABR Ⅴ波阈值和鼓室图与穿刺术前比较无统计学差异（P>0.05）。结论鼓室置管术治疗婴儿期SOM,听力恢复快且疗效稳定,虽有发生并发症的可能,但仍是较好的治疗手段;鼓膜穿刺术在1周内的疗效较好,但复发率高,最好不作为婴儿期腭裂SOM的常规治疗手段。     

Trigeminal somatosensory evoked potentials: a normal value study.

Normal somatosensory evoked potentials were obtained from the lower lip of 40 volunteers. Efforts were made to exclude artefact. A consistent triphasic wave form of three peaks and troughs was defined. There were greater variations in amplitude than latency between subjects. Statistically, one side of the lower lip can be used as a control for the contralateral side, but it may not be possible to have reliable normal values between subjects. Somatosensory evoked potentials may however represent an objective method of evaluating trigeminal sensory nerve function.     

Quantitative Performance Characterization of Radiation Dose for the Carestream CS9600 Cone-Beam Computed Tomography Machine

IntroductionCone-beam computed tomography (CBCT) machines produce relatively low levels of harmful ionizing radiation, as compared with the computed tomography devices used in medical practices. The Carestream CS9600 CBCT imaging device has been recently introduced into the marketplace, and the manufacturer reports the use of an increased x-ray tube voltage (120 kVp) for the device, along with a reduced patient dose that is achieved using added filtration. Independent dosimetry studies are performed to ensure appropriate radiation exposure dose levels are within recommended safety guidelines.The purpose of this study is to independently evaluate and measure the radiation exposure dose performance parameters of the CS9600 CBCT, including its multiple field of view, exposure settings, and filtration options.MethodsA thimble ionization chamber and PMMA phantom were used to characterize dose index using the established SEDENTEXTCT evaluation method.ResultsThe phantom-obtained radiation dose index measures ranged from 0.128782–13.848 milligrays (mGy) for the various scanning options evaluated. The field of view, type of filter used, and phantom size all had a direct impact on the relationship between the experimentally obtained dose index measures and the dose area product values reported by the manufacturer.ConclusionsA strong linear correlation was observed between the experimentally obtained dose index measures and the manufacturer-reported dose area product values. The 0.7 mm Cu filter that has been added to the CS9600 reduced the exposure dose index measures even with the x-ray tube kilovoltage peak (kVp) being increased to 120 kVp, as compared with the 0.15 mm Cu filter at 90 kVp.     

Quantitative ultrasound imaging of healthy and reconstructed cleft lip: a feasibility study.

OBJECTIVE: To investigate the feasibility of echographic imaging of healthy and reconstructed cleft lip and to estimate tissue dimensions and normalized echo level. METHODS: Echographic images of the upper lip were made on three healthy subjects and two patients using a linear array transducer (7 to 11 MHz bandwidth) and a noncontact gel coupling. Tissue dimensions were measured using calipers. Echo levels were calibrated and were corrected for beam characteristics, gel path, and tissue attenuation using a tissue-mimicking phantom. RESULTS: At the central position of the philtrum, mean thickness (SD) of lip loose connective tissue layer, orbicularis oris muscle, and dense connective layer was 4.0 (0.1) mm, 2.3 (0.7) mm, and 2.2 (0.7) mm, respectively, in healthy lip at rest; and 4.1 (0.9) mm, 3.8 (1.7) mm, and 2.6 (0.6) mm, respectively, in contracted lip. Mean (SD) echo level of muscle and dense connective tissue layer with respect to echo level of lip loose connective tissue layer was -19.3 (0.6) dB and -10.7 (4.0) dB, respectively, in relaxed condition and -20.7 (1.5) dB and -7.7 (2.3) dB, respectively, in contracted state. Color mode echo images were calculated, showing lip tissues in separate colors and highlighting details like discontinuity of the orbicularis oris muscle and presence of scar tissue. CONCLUSIONS: Quantitative assessment of thickness and echo level of various lip tissues is feasible after proper echographic equipment calibration. Diagnostic potentials of this method for noninvasive evaluation of cleft lip reconstruction outcome are promising.     

Electrophysiological method to examine muscle fiber architecture in the upper lip in cleft-lip patients

Objectives

The upper lip’s musculature comprises several muscle fiber groups with different spatial orientations for various lip movements. In the past, it has not been possible to describe these various groups and their motor units in detail with traditional methods of electromyography (EMG). The purpose of this investigation was to create a viable method for studying the architecture of upper-lip muscle fibers in patients with surgically closed cleft lip by refining the design of a flexible electrode array for multichannel EMG.

Methods

Calibrated perioral photographs of 36 adult subjects were used to determine the basic geometry of an electrode array for use on different facial shapes. A total of 256 chloride silver electrodes, 1 mm in diameter, were distributed over this geometry to form a grid with interelectrode distances of 2.5 mm. Technical implementation of the electrode array was based on a modified technique used for flexible printed circuit boards. A double-sided adhesive tape with perforations was used to apply the array to the skin in the upper-lip area. Surface EMG signals were recorded while the subjects were performing various lip movements and exerting specific lip forces. The latter were recorded with a specially developed transducer.

Results

Despite an extremely dense grid of electrodes associated with downsized contacts, the electrode array could be precisely applied to the perforated adhesive tape. The electrode array remained firmly attached to the skin even during extensive lip movements. The recorded EMG signals offered high baseline stability and a strong signal-to-noise ratio, thus, allowing us to extract individual motor unit action potentials (MUAPs). Spatiotemporal tracking of MUAPs succeeded in demonstrating the course of muscle fibers belonging to individual motor units. Pilot measurements taken on subjects with surgically closed unilateral cleft lip revealed an asymmetric distribution of muscle activity surrounding the closed cleft-lip segments.

Conclusion

Our refined noninvasive electrophysiological method is capable of providing detailed information about muscle fiber architecture and the position, size, and organization of motor units in the lip area. It is thus feasible to conduct further studies to analyze differences in muscle morphology and motor control between surgically treated cleft-lip patients and noncleft individuals.     

Immediate unrestricted feeding of infants following cleft lip and palate repair.

Postoperative feeding regimens after cleft lip and palate repair continue to be a controversial issue. This study was designed to test the feasibility of immediate unrestricted feeding after lip and palate closure with attention to operative outcome or complications. A retrospective analysis of two feeding protocols involved 80 infants with both unilateral and bilateral defects. Protocol A utilized tube and syringe feedings, and protocol B utilized unrestricted bottle or breast feedings. There were no instances of lip or palate wound complications in the unrestricted group. We conclude that immediate unrestricted feeding may be instituted safely, thus improving and simplifying postoperative management after cleft lip and/or palate repair.     

瘢痕对唇腭裂上颌骨生长影响的有限元分析

目的探究唇腭裂术后瘢痕对上颌骨生长影响的作用机制。方法在原腭裂上颌骨有限元模型上,通过ANSYS软件中布尔操作技术进行上唇软组织的添加,形成含上唇软组织的唇腭裂上颌骨三维有限元模型,在模型上同时添加上唇压力及腭部瘢痕力,观察上颌骨的变化情况。结果两侧上颌骨均出现形变,由前向后形变幅度逐渐降低,且存在不对称性。三维方向上形变比较:X轴>Z轴>Y轴。结论唇腭裂手术瘢痕对上颌骨生长产生明显抑制,由前向后抑制程度逐渐降低,牙槽突前段受抑制最明显;上颌骨在三维方向上生长呈现出不对称性;三维方向抑制程度比较:横向>矢状向>垂直向。     

Expression of apoptotic and cell proliferation regulatory proteins in actinic cheilitis

BACKGROUND: Actinic cheilitis (AC) is a pre-malignant lesion caused by ultraviolet (UV) radiation. The apoptotic proteins p53, bax, bcl-2, and the proliferation marker Ki-67, are known to play an important role in UV-exposed skin and carcinomas, therefore, these markers were assessed in AC and compared with normal lip and oral mucosa. METHODS: AC (n = 13), normal lip (n = 7) and oral mucosa (n = 6) biopsies were stained immunohistochemically for p53, bax, bcl-2 and Ki-67, to determine their expression and distribution. RESULTS: p53 was over-expressed in AC as compared with normal lip and oral mucosa (P < 0.003). Although bcl-2 expression was higher in AC than in oral mucosa (P < 0.002), it was significantly reduced as compared with normal lip (P < 0.04). Bax expression remained unchanged, and Ki-67 was significantly increased in AC and normal lip as compared with oral mucosa (P < 0.05). CONCLUSION: The results suggest that DNA-damaged cells by UV radiation in AC are eliminated by apoptosis.     

Mandibular metastasis from a primary adenocarcinoma of the fallopian tube

A case of a metastatic lesion to the mandible from a Fallopian tube carcinoma is reported. The presenting symptoms were altered lip sensation and an intraoral mass. A previous history of pelvic infection was reported, but later a diagnosis of adenocarcinoma of the left Fallopian tube was made. Metastatic spread also involved other bones and the liver. No previous case of a metastatic lesion to the oral cavity from the Fallopian tubes has been reported.     

Red bone marrow doses, integral absorbed doses, and somatically effective dose equivalent from four maxillary occlusal projections

Phantom measurements of red bone marrow (RBM) doses, integral absorbed doses, and somatically effective dose equivalent (SEDE) from four different maxillary occlusal projections are presented. For each projection, different combinations of focus-skin distances and tube potentials were compared with regard to the patient's radiation load. The axial incisal view produced the highest patient exposures, with a maximum red bone marrow dose of 122.5 microGy/exposure, integral absorbed dose of 8.6 mJ/exposure, and SEDE values of 39.6 microSv/exposure. The corresponding values from the frontal, lateral occlusal, and tuber views ranged between 4% and 44% of the axial incisal view values for the integral absorbed dose and SEDE values, and between 0.3% and 3% for the red bone marrow doses. Increasing the focus-skin distance from 17.5 cm to 27 cm is accompanied by a 24% to 30% reduction in integral absorbed dose. Increasing the tube potential from 50 kV to 65 kV likewise results in a 23% reduction in absorbed energy.     

Cephalometric comparisons of individuals from India and Mexico with unoperated cleft lip and palate

The purpose of the study is to determine whether the presence of unoperated clefts of the lip and alveolus or cleft lip and palate have similar effects on the dentofacial relationships of individuals with different racial backgrounds. Nineteen individuals from India and eighteen from Mexico with either unoperated unilateral cleft lip and alveolus or unilateral cleft lip and palate were examined cephalometrically and compared to matched normal individuals. The first step in the data analysis was to compare the normal subjects in the Indian and Mexican samples. Because many statistically significant differences were found between the normal groups, each measure for each patient with a cleft was expressed as a percentage of the mean value for the matched normal group. These relative values for the different measures were then entered into analyses of variance to compare the Indian and Mexican groups with clefts. Subgroups with cleft lip and alveolus were analyzed separately from subgroups with cleft lip and palate. Few group comparisons based on the relative measures were statistically significant, thus suggesting that there was a great similarity in the dentofacial relationships of unoperated individuals with the same cleft type. If the present results are further substantiated by future studies, these findings should enable investigators to pool data on unoperated individuals from various sources. Such an approach can lead to a better understanding of the differences between the various cleft types while eliminating the masking effect of surgical or orthodontic treatment.     

Phenotypical analysis of children with congenital cleft of upper lip and palate

The relation between congenital cleft of upper lip and palate with dysplasia of connective tissue was studied. 102 patients (aged from 1 to 14 years) with various kinds of congenital cleft of upper lip and palate were observed. The reports showed phenotypical attributes of dysplasia of connective tissue of patients with similar pathology. The data on the character and prevalence of external features are received from children with congenital cleft of upper lip and palate.     

Ornithine-vasopressin gangrene and reconstruction of the upper lip. Case report

A bilateral cleft lip and palate case received ornithine-vasopressin intra-operatively in preparation for a vasoconstricted field of the various lip segments prior to the repair of the cleft lip. A cyanotic tinge appeared immediately. This eventually led to total necrosis of the upper lip. Various relevant blood tests were done and a mild thrombocytosis was found. Surgical reconstruction of the upper lip was performed by means of a forked cross-lip flap--the main blood supply coming from the columella--as well as by means of an inferiorly pedicled cheek flap from the para-nasal area.     

个体化双侧唇裂修复术式的设计

目的：探讨能使双侧唇裂修复术后唇及唇弓形态对称的个体化裂修复术式。方法;以双侧唇裂术前鼻小柱基部两侧至前唇唇峰点,以及两侧鼻翼基部至侧唇唇峰的距离是否对称作标准。将术前双侧唇裂的畸形特点分为５种类型,并针对每一种类型的畸形特点设计手术术式。结果;共设计出５种双侧唇裂修复术式,每一种术式仅适用一种双侧唇裂术前畸形的手术修复。     

Feeding difficulties in craniofacial microsomia: A multicenter retrospective analysis of 755 patients

A retrospective cohort study was initiated to analyse the prevalence, risk factors and treatment modalities of feeding difficulties in patients with craniofacial microsomia. This study included 755 subjects with craniofacial microsomia from three craniofacial centres. Medical charts were reviewed for severity of the deformity, documented feeding difficulties, age at which feeding difficulties first presented and treatment, presence of cleft lip/palate, extracraniofacial anomalies, and obstructive sleep apnoea. In total, 199 patients (26.4%) had documented feeding difficulties. Patients with bilateral involvement, Pruzansky-Kaban III classification, cleft lip/palate, or obstructive sleep apnoea were significantly more at risk for developing feeding difficulties and significantly more often needed additional feeding via a nasogastric tube than patients without these risk factors.     

单侧唇裂术后继发红唇畸形整复

目的总结60例单侧唇裂术后红唇畸形整复的效果。方法对60例单侧唇裂术后红唇畸形采用综合应用各种局部皮辩法进行整复。结果60例手术患者效果良好。结论60例手术患者整体效果良好。唇裂术后畸形整复存在一定的难度和复杂性，手术设计应灵活掌握，创造和恢复红唇对称性及两者协调关系是治疗的重要原则。     

个体化单侧唇裂修复术式的改进

进一步探讨对每一例单侧唇裂患者畸形特点更具针对性的个体化单侧唇裂修复术式的设计,使手术设计简便,以利临床应用。方法：采用几何学解析的方法,以正常人两侧鼻民办基部和鼻小柱基部点到两侧唇峰的距离相等为模板,对个体化单侧唇上鼻小柱下方切口止点的设计是以健患侧唇峰与人中切迹连线所成夹角的角平分线和健侧人中嵴的交点定点;患侧鼻翼基部点的设计则是以过健侧鼻翼基部水平线与患侧鼻翼外侧缘的交点定的设计原则,根据单     

Somatic radiation load by radiography of the temporomandibular joint]

660 exposures were performed on an Alderson phantom to determine the somatic radiation exposure values for standard examinations of the temporomandibular joint. Comparative examinations with the classic contact technique according to Parma served to make clear the results obtained. The lowest amount of surface exposure was observed in contact examinations of the temporomandibular joint. The use of a flat tube leads to a 13-fold reduction in surface exposure compared to contact examinations according to Parma. Furthermore, a heavy gradient of radiation exposure from the area of exposure to the environment was stated in using a tube (flat tube and ear tube).     

Antenatal transabdominal ultrasound detection of cleft lip and palate in Western Australia from 1996 to 2003.

OBJECTIVE: To determine the frequency of detection of cleft lip with or without cleft palate and isolated cleft palate from antenatal ultrasound examinations conducted on mothers of infants born with cleft lip and/or palate and isolated cleft palate in Western Australia from 1996 to 2003. DESIGN: Review of patient records and purpose-designed questionnaire sent to parents of children born with cleft lip and/or palate and isolated cleft palate. RESULTS: There were 308 infants born with cleft lip and/or palate and isolated cleft palate in the study period. Of the 293 parents, 218 responses were available for the study (70.7%), and 2.9 +/- 1.8 SD antenatal ultrasound scans were performed on 216 women. No such scans were performed on two women. Cleft lip and/or palate was detected in 22.2% of cases. There was no detection prior to 15 weeks gestational age in the 137 women screened. Between 15 and 19 weeks gestational age, 174 scans detected 30 cases. Between 20 and 29 weeks gestational age, 84 scans detected 11 cases. Between 30 and 40 weeks gestational age, 66 scans detected 7 cases. The detection rate for bilateral cleft lip and/or palate was 44.4% and for unilateral cleft lip and/or palate, 40.6%. Detection rate for isolated cleft lip was 33.3%. Antenatal ultrasound failed to detect any infants with an isolated cleft palate (n = 95). The rate of detection of cleft lip and/or palate increased through the study period. CONCLUSIONS: The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.     

Reduction of nasal fracture using an airway tube as a pivot

When repairing nasal fracture by closed reduction, an airway tube is useful for the pivot of the forceps. By placing the tube on the upper white lip and using it as a pivot, the fracture is reduced with Walsham forceps or Langenbeck elevator. This method is useful for all nasal fractures that are too firm to reduce by conventional closed reduction.