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A retrospective study of 28 alveolar cleft grafts
Scientific Poster Session Brandenburg, G., Leibrock, LG., Shuman, R., Malette, W.G. and Quidly, H.: Chit-an, a new topical hemostatic agent for diffuse capillary bleeding in brain tissue. Neurosurgery. July 15( 1):9-13, 1984 Funding provided by Hoechst Roussel Pharmaceutical
Efleet of the Sexual Diflerence on the Development of Cleft Lip, Palate in Humans Shigeki Miura, DDS, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l 1 Suemori-dori, Chikusa-ku, 464 JAPAN (Natsume, N., Fujiwara, H., Nakamura, T., Horiuchi, R., Kawai, T.) Purpose: The current study was designed to analyze epidemiological patterns in the development of cleft lip or palate and to clarify a mechanism of each process of these deformities in humans. Method: Investigations were made on cleft lip or palate in 532 patients whose facial and oral models coded for computerized analysis were classified by 6 for lip, 4 for alveolus and 7 for palate in a total of 17 sections. Results: (1) In 353 cleft lip patients, the ratio of cleft patterns on both the right and left sides was proved to be higher in males than in females. The ratios were as high as 73.3% in males with a cleft of the right side vermilion on lip alone and 64.3% in males with a cleft of the left side vermilion alone, although no differences between the sexes were noted in bilateral complete cleft of the lip. It was also found that the ratio of the right side was always higher than that of the left side in males when there was no difference in the severity of the cleft. (2) In 179 cleft palate patients, it was found that more women showed a notably high level of severity, although the ratio of males became higher when the severity of cleft became weaker, indicating no sexual difference in bifid uvula. The results of our current investigations suggested a close correlation between the pathogenic factors and sex in the above patients with cleft lip or palate. Funding provided by the Ministry of Education in Japan
Teratogenicity Caused by Halothane and Enflurane, and Changes Depending on 0, Concentration Nagato Natsume, DDS, PhD, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l 1 Suemori-dori, Chikusa-ku, Nagoya 464 JAPAN (Miura, S., Nakamura, T., Horiuchi, R., Kawai, T.) In an attempt to reexamine the teratogenicity of anesthetic drugs in consideration of individual differences in drug sensitivity, we re-examined the teratogenicity of 136
enflurane using A/J strain mice on the 1 lth day of gestation as a model for a group with high liability such as is the case in lineages where there is occurrence of cleft palate in humans, under the detrimental conditions of being exposed to an anesthetic gas in the organogenesis period. The animals, one group 30-40 mothers used in this study were strain ddY and strain A/J mice, the same as those of previous reports. (ddY: spontaneous rate of cleft palate 0.02%, A/J: 5.4%) Exposure Conditions and Observation Period: Based on results of preliminary examinations, animals in the 11th day of gestation were exposed to enflurane for 8 hours under three different conditions of air (approximately 21% 0, concentration), air and oxygen (approximately 60% 0, concentration) and pure oxygen (100% concentration at 2 liters/min). Cesarean section was performed on the 18th day of gestation and the fetus was examined for the presence of abnormalities. The results of this testing indicated that under these conditions, enflurane caused the occurrence of cleft palate in the same manner as halothane. However, we also reported that the rate of occurrence was lower than that of halothane and there were no cases of fetuses with cleft palate observed in the ddY strain mice which served as the control group. Further, it was also suggested that in the case of cleft palate that is seen in high liability groups such as A/J strain mice, it is possible to prevent to a certain extent the occurrence of cleft palate by increasing the concentration of oxygen in the anesthetic. Funding provided by the Ministry of Education in Japan
A Retrospective Study of 28 Alveolar Cleft Grafts Brian K. Smith, DDS, Cleveland Metro General Hospital, 3395 Scranton Rd., Cleveland, OH 44109 (Haug, R., Indresano, A.T.) Retrospective studies of patient care serve to identify relative success or failure of clinical procedures in relation to particular surgical problems. The purpose of this study was to review the surgical treatment of alveolar clefts, and to identify particularly successful techniques and surgical problems that were high risk. Hospital charts and craniofacial defect team notes of 28 patients with alveolar clefts treated surgically, over a period of 4 years, were reviewed by 3 investigators . Age, sex, alveolar cleft location, graft material, and procedures were identified. Complications including infection, recurrent oronasal fistula, loss of graft, and wound dehiscence were identified and grouped according to age, sex, location, procedure and material. Of the 28 patients reviewed 14 were males and 14 were females. Seventeen of the AAOMS
.
1989
scientific Poster Session
alveolar clefts were on the left side, 7 clefts were on the right, and 5 were bilateral clefts. The ages ranged from 5-41 years with a mean of 13 years and a median of 10 years. Maxillary osteotomies were performed in 2 cases in conjunction with grafting procedures. Ten patients received cancellous grafts, 9 received corticocancellous grafts, 7 had tricaicium phosphate, and 2 had hydroxylapatite grafts. The following results were obtained in the tricalcium phosphate group. One of 7 patients had an oro-nasal fistula. Four of 7 patients did not have eruption into the graft site. Four of 7 patients did not begin orthodontic therapy. Three of seven patients had eruption into the graft site. The hydroxylapatite group had the following results. One of 2 patients had a dehiscence. None of the cases had eruption into the graft site. The corticocancellous groups had the following results. One of 9 patients had an oro-nasal fistula. Five of 9 patients had eruption into the graft site. Five of 9 went on to orthodontic therapy. The cancellous group had the following results. One of 10 patients had an oro-nasal fistula, and 2 had dehiscences. One of 10 patients had an oro-nasal fistula, and 2 had dehiscences. Seven of 10 patients had eruption into the graft site. Eight of 10 patients went on to orthodontic therapy. Bilateral clefts had a higher rate of failure than unilateral clefts right and left. The complications were evenly distributed throughout the graft material, however, the hydroxylapatite was a complete failure relative to the criteria reviewed. Finally, males were affected by complications more than were females. This study identifies a patient population similar to other reports in regard to age, sex, location, and materials. Of particular note is the identification of bilateral clefts, osteotomies in concert with grafting procedures, and male patients as being in the highest risk categories. In addition, 80% of the cancellous grafts went on to orthodontic treatment.
Bone scintigraphy has been used for detecting bone metastases, osteomyelitis, and to evaluate fracture healing and metabolic bone disorders. In this study we quantified the bone uptake of Technetium-99m-diphosphonate (Tc-99m-MDP) in several mandibular diseases in order to differentiate pathologic conditions. Materials and methods: Bone scintigraphy was performed in 37 cases of mandibular diseases, distributed as follows: osteoradionecrosis (n- 13 1, fractures (n=9). invaded oral carcinomas (n = 7), ameloblastomas (n = 3)” radicular cysts (n = 3), and diffuse sclerosing osteomyelitis (n=2). The scintigrams were obtained 4 hours after intravenous injection of Tc-99m-MDP (0.25 mCi/Kg body weight). Frontal, right and left lateral images were acquired using a large field of view (LFOV) gamma camera with parallel-hole collimator. ‘The system was interfaced with a computer. Regions of bone lesions (B) and the cerviml soft-tissue (ST), each 3x3 pixel in size, were selected for quantification of radioactivity from the computer assisted scintigrams. The relative uptake in the lesion was presented as B/ST ratio. Results: The B/ST ratio increased (mean 6.49 + I.3 1 I in the region of the invaded malignant tumors and was statistically (~~0.05) higher at the lesion than that observed in the reference contralateral side of the mandible. The B/ST ratio of the radicular cysts was significantly lower than those of the invaded carcinomas, ameloblastomas, and diffuse sclerosing osteomyelitis. The results showed that the quantitative method using Tc99m-MDP scintigraphy can contribute to differentiating pathological bone conditions.
References Alexander, J.M.: Radionuclide bone scanning in the diagnosis of lesions of the maxiilofacial region. J Oral Surgery 34:249-256, 1976 Shafer, R.B., Marlette, J.M. et al.: The role of Tc-99-m phosphate complexes and gallium-67 in the diagnosis and management ofmaxillofacial disease. J Nucl Med 22:8- 11. I98 I
References Funding Troxell, J.B.. Fonseca, R.J. and Osbon, D.B.: A Retrospective Study of Alveolar Cleft Grafting. J Oral Maxillofac Surg 401721-725, 1982 Hall, H.D. and Posnick, J.C.: Early Results of Secondary Bone Grafts in 106 Alveolar Clefts. J Oral Maxillofac Surg 41:289-294, 1983 Funding
provide by Cleveland
Metropolitan
General
Hospital
Evaluation of Quantification of Tc-99m-MDP Uptake, Bone to Soft-tissue Ratio, in Miscellaneous Pathologic Mandibles Makoto Tsuchomochi, DDS, DDSc, NIH, NIDR, Diagnostic Systems Branch, Bldg. 1O/ 1N 106,900O Rockville Pike, Bethesda, MD 20892 (Kato, J., Hosain, F., Ruttimann, U.E.) AAOMS
l
1989
provided by NIH
Incidence of Cleft Lip and Palate in 249,832 Japanese Babies Tsuyoshi Kawai, DDS, PhD, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l I Suemori-dori, Chikusa-ku, Nagoya 464 JAPAN (Natsume, N., Suzucki, T.) Purpose: The purpose of the current investigation was to determine whether patients with cleft lip_ and/or palate I . in Japan have increased in recent years. Method: Since 1982, any information such as birth date, birth weight, and complications, collected on newborns with cleft lip and/or palate who were referred to 137
Efleet of the Sexual Diflerence on the Development of Cleft Lip, Palate in Humans Shigeki Miura, DDS, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l 1 Suemori-dori, Chikusa-ku, 464 JAPAN (Natsume, N., Fujiwara, H., Nakamura, T., Horiuchi, R., Kawai, T.) Purpose: The current study was designed to analyze epidemiological patterns in the development of cleft lip or palate and to clarify a mechanism of each process of these deformities in humans. Method: Investigations were made on cleft lip or palate in 532 patients whose facial and oral models coded for computerized analysis were classified by 6 for lip, 4 for alveolus and 7 for palate in a total of 17 sections. Results: (1) In 353 cleft lip patients, the ratio of cleft patterns on both the right and left sides was proved to be higher in males than in females. The ratios were as high as 73.3% in males with a cleft of the right side vermilion on lip alone and 64.3% in males with a cleft of the left side vermilion alone, although no differences between the sexes were noted in bilateral complete cleft of the lip. It was also found that the ratio of the right side was always higher than that of the left side in males when there was no difference in the severity of the cleft. (2) In 179 cleft palate patients, it was found that more women showed a notably high level of severity, although the ratio of males became higher when the severity of cleft became weaker, indicating no sexual difference in bifid uvula. The results of our current investigations suggested a close correlation between the pathogenic factors and sex in the above patients with cleft lip or palate. Funding provided by the Ministry of Education in Japan
Teratogenicity Caused by Halothane and Enflurane, and Changes Depending on 0, Concentration Nagato Natsume, DDS, PhD, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l 1 Suemori-dori, Chikusa-ku, Nagoya 464 JAPAN (Miura, S., Nakamura, T., Horiuchi, R., Kawai, T.) In an attempt to reexamine the teratogenicity of anesthetic drugs in consideration of individual differences in drug sensitivity, we re-examined the teratogenicity of 136
enflurane using A/J strain mice on the 1 lth day of gestation as a model for a group with high liability such as is the case in lineages where there is occurrence of cleft palate in humans, under the detrimental conditions of being exposed to an anesthetic gas in the organogenesis period. The animals, one group 30-40 mothers used in this study were strain ddY and strain A/J mice, the same as those of previous reports. (ddY: spontaneous rate of cleft palate 0.02%, A/J: 5.4%) Exposure Conditions and Observation Period: Based on results of preliminary examinations, animals in the 11th day of gestation were exposed to enflurane for 8 hours under three different conditions of air (approximately 21% 0, concentration), air and oxygen (approximately 60% 0, concentration) and pure oxygen (100% concentration at 2 liters/min). Cesarean section was performed on the 18th day of gestation and the fetus was examined for the presence of abnormalities. The results of this testing indicated that under these conditions, enflurane caused the occurrence of cleft palate in the same manner as halothane. However, we also reported that the rate of occurrence was lower than that of halothane and there were no cases of fetuses with cleft palate observed in the ddY strain mice which served as the control group. Further, it was also suggested that in the case of cleft palate that is seen in high liability groups such as A/J strain mice, it is possible to prevent to a certain extent the occurrence of cleft palate by increasing the concentration of oxygen in the anesthetic. Funding provided by the Ministry of Education in Japan
A Retrospective Study of 28 Alveolar Cleft Grafts Brian K. Smith, DDS, Cleveland Metro General Hospital, 3395 Scranton Rd., Cleveland, OH 44109 (Haug, R., Indresano, A.T.) Retrospective studies of patient care serve to identify relative success or failure of clinical procedures in relation to particular surgical problems. The purpose of this study was to review the surgical treatment of alveolar clefts, and to identify particularly successful techniques and surgical problems that were high risk. Hospital charts and craniofacial defect team notes of 28 patients with alveolar clefts treated surgically, over a period of 4 years, were reviewed by 3 investigators . Age, sex, alveolar cleft location, graft material, and procedures were identified. Complications including infection, recurrent oronasal fistula, loss of graft, and wound dehiscence were identified and grouped according to age, sex, location, procedure and material. Of the 28 patients reviewed 14 were males and 14 were females. Seventeen of the AAOMS
.
1989
scientific Poster Session
alveolar clefts were on the left side, 7 clefts were on the right, and 5 were bilateral clefts. The ages ranged from 5-41 years with a mean of 13 years and a median of 10 years. Maxillary osteotomies were performed in 2 cases in conjunction with grafting procedures. Ten patients received cancellous grafts, 9 received corticocancellous grafts, 7 had tricaicium phosphate, and 2 had hydroxylapatite grafts. The following results were obtained in the tricalcium phosphate group. One of 7 patients had an oro-nasal fistula. Four of 7 patients did not have eruption into the graft site. Four of 7 patients did not begin orthodontic therapy. Three of seven patients had eruption into the graft site. The hydroxylapatite group had the following results. One of 2 patients had a dehiscence. None of the cases had eruption into the graft site. The corticocancellous groups had the following results. One of 9 patients had an oro-nasal fistula. Five of 9 patients had eruption into the graft site. Five of 9 went on to orthodontic therapy. The cancellous group had the following results. One of 10 patients had an oro-nasal fistula, and 2 had dehiscences. One of 10 patients had an oro-nasal fistula, and 2 had dehiscences. Seven of 10 patients had eruption into the graft site. Eight of 10 patients went on to orthodontic therapy. Bilateral clefts had a higher rate of failure than unilateral clefts right and left. The complications were evenly distributed throughout the graft material, however, the hydroxylapatite was a complete failure relative to the criteria reviewed. Finally, males were affected by complications more than were females. This study identifies a patient population similar to other reports in regard to age, sex, location, and materials. Of particular note is the identification of bilateral clefts, osteotomies in concert with grafting procedures, and male patients as being in the highest risk categories. In addition, 80% of the cancellous grafts went on to orthodontic treatment.
Bone scintigraphy has been used for detecting bone metastases, osteomyelitis, and to evaluate fracture healing and metabolic bone disorders. In this study we quantified the bone uptake of Technetium-99m-diphosphonate (Tc-99m-MDP) in several mandibular diseases in order to differentiate pathologic conditions. Materials and methods: Bone scintigraphy was performed in 37 cases of mandibular diseases, distributed as follows: osteoradionecrosis (n- 13 1, fractures (n=9). invaded oral carcinomas (n = 7), ameloblastomas (n = 3)” radicular cysts (n = 3), and diffuse sclerosing osteomyelitis (n=2). The scintigrams were obtained 4 hours after intravenous injection of Tc-99m-MDP (0.25 mCi/Kg body weight). Frontal, right and left lateral images were acquired using a large field of view (LFOV) gamma camera with parallel-hole collimator. ‘The system was interfaced with a computer. Regions of bone lesions (B) and the cerviml soft-tissue (ST), each 3x3 pixel in size, were selected for quantification of radioactivity from the computer assisted scintigrams. The relative uptake in the lesion was presented as B/ST ratio. Results: The B/ST ratio increased (mean 6.49 + I.3 1 I in the region of the invaded malignant tumors and was statistically (~~0.05) higher at the lesion than that observed in the reference contralateral side of the mandible. The B/ST ratio of the radicular cysts was significantly lower than those of the invaded carcinomas, ameloblastomas, and diffuse sclerosing osteomyelitis. The results showed that the quantitative method using Tc99m-MDP scintigraphy can contribute to differentiating pathological bone conditions.
References Alexander, J.M.: Radionuclide bone scanning in the diagnosis of lesions of the maxiilofacial region. J Oral Surgery 34:249-256, 1976 Shafer, R.B., Marlette, J.M. et al.: The role of Tc-99-m phosphate complexes and gallium-67 in the diagnosis and management ofmaxillofacial disease. J Nucl Med 22:8- 11. I98 I
References Funding Troxell, J.B.. Fonseca, R.J. and Osbon, D.B.: A Retrospective Study of Alveolar Cleft Grafting. J Oral Maxillofac Surg 401721-725, 1982 Hall, H.D. and Posnick, J.C.: Early Results of Secondary Bone Grafts in 106 Alveolar Clefts. J Oral Maxillofac Surg 41:289-294, 1983 Funding
provide by Cleveland
Metropolitan
General
Hospital
Evaluation of Quantification of Tc-99m-MDP Uptake, Bone to Soft-tissue Ratio, in Miscellaneous Pathologic Mandibles Makoto Tsuchomochi, DDS, DDSc, NIH, NIDR, Diagnostic Systems Branch, Bldg. 1O/ 1N 106,900O Rockville Pike, Bethesda, MD 20892 (Kato, J., Hosain, F., Ruttimann, U.E.) AAOMS
l
1989
provided by NIH
Incidence of Cleft Lip and Palate in 249,832 Japanese Babies Tsuyoshi Kawai, DDS, PhD, Second Dept. of OMS, Schl of Dentistry, Aichi-Gakuin University, 2-l I Suemori-dori, Chikusa-ku, Nagoya 464 JAPAN (Natsume, N., Suzucki, T.) Purpose: The purpose of the current investigation was to determine whether patients with cleft lip_ and/or palate I . in Japan have increased in recent years. Method: Since 1982, any information such as birth date, birth weight, and complications, collected on newborns with cleft lip and/or palate who were referred to 137