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Poster 198: Systemic Inflammatory Response Syndrome and Postoperative Complications After Orthognathic Surgery
Scientific Poster Session
POSTER 197 Molecular and Clinical Approach in a Japanese Family With CL/P and a Balanced Translocation t (9;17)(q32; q12) Atsuo Kaetsu, DDS, PhD, Japan (Machida J; Kamamoto M; Yamamoto T; Sumiyoshi S; Moon M) Statement of the Problem: Cleft lip and/or palate (CL/P) are common birth defects of multifactorial etiology by both genetic and environmental factors (1). Recently, we found a Japanese family with a balanced translocation t(9;17)(q32;q12). Of three generations with translocation, one subject has cleft lip and palate. It has been demonstrated that facial development is associated with genes on chromosome 9q and 17q (2), leading to a possibility that genes disrupted by the translocation may play an important role in clefting. The purposes of this study are following; 1) Identification of genes underlying the breakpoints of the translocation. 2) Determine the association of the disrupted genes with the occurrence of CL/P. Here, we report a molecular genetic analysis and clinical examination of this family. Materials and Methods: A male infant was born prematurely by cesarean section at 24th gestational age after an uneventful pregnancy. His birth weight and height were 706 g and 31.8 cm, respectively. He had ocular hypertelorism, a bilateral cleft lip and palate, and a mild flat nose. His father and paternal grandmother had the same translocation of 9q32 and 17q12 as seen in the patient, while no family history of malformations. 1) We determined the breakpoints of the translocation by fluorescence in situ hybridization (FISH) analysis using BAC clones and subsequent long range PCR analysis using established lymphoblastoid cell lines. 2) In order to study the role of these candidate genes in forming a cleft, we examined clinical data and findings. Method of Data Analysis: The PCR products covering the breakpoint were analyzed on ABI 3700 automated sequencer, after the reaction with BigDye. The Applied Biosystems sequence software (version 2.1.2) was used for lane tracking. Chromatograms were transferred to a UNIX workstation, base called with PHRED 4.0 (http:// droog.mbt.washington.edu/poly_doc40.html) and results viewed with CONSED program (version 4.0) (3). The UCSC (http://genome.ucsc.edu/cgi-bin/hgGateway) database was used to detect potential genes around the breakpoint. Then, the gene function is examined by biochemical test of the patient. Results: 1) Sequence analysis demonstrated that two genes, SLC31A1 (Solute Carrier Family 31 Member 1) on AAOMS • 2007
chromosome 9 and CCL2 (Chemokine Ligand 2) on chromosome 17, were rearranged with the breaks occurring within their introns.2) Although, SLC31A1 is associated with a transportation element essential for life, copper, so far, we did not find any clinical evidence for the Copper metabolism disorder in the patient. Conclusion: Although, the present data support that genes may play an important role in facial development, it is necessary to extend an additional investigation of Copper metabolism. References Orofacial clefting: recent insights into a complex trait. Jugessur A and Murray JC; Curr Opin Genet Dev. 2005 Jun;15(3):270-8 Meta-analysis of 13 genome scans reveals multiple cleft lip/palate genes with novel loci on 9q21 and 2q32-35. Mary L. Marazita, Jeffrey C. Murray, et.al, Am J Hum Genet. 2004 August; 75(2): 161–173 PolyPhred: automating the detection and genotyping of single nucleotide substitutions using fluorescence-based resequencing. Nickerson DA, Tobe VO, Taylor SL. Nucleic Acids Res. 1997 Jul 15;25(14): 2745-51
POSTER 198 Systemic Inflammatory Response Syndrome and Postoperative Complications After Orthognathic Surgery Kiyohiro Kasahara, PhD, Japan (Kamio T; Takaki T; Uchiyama T; Takano N; Shibahara T) Statement of the Problem: The concept of “systemic inflammatory response syndrome” (or SIRS) was proposed at American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference in 1991. SIRS symptoms immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. Reports discussing the relationship between operative stress and SIRS are found in the field of digestive surgery, but not in that of oral surgery. Materials and Methods: Sixty jaw deformity cases who had undergone orthognathic surgery from September 2003 to October 2006 were involved in this study. Method of Data Analysis: We assigned 27 cases who met two of the several diagnostic criteria for SIRS and continued to meet them for at least 24 hours after surgery to the SIRS group. The other 33 patients were assigned to the non-SIRS group. Results: Postoperative complications occurred in 22.1% of the SIRS group and 0.0% of the non -SIRS group (p ⬍ 0.05). In six cases, the postoperative fluctuation of IL-6 level was evaluated. Conclusion: These results suggest the importance of careful management of postoperative SIRS patients to prevent complications. 43.e111
Scientific Poster Session References
References
Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 20 Rangel-Frausto, M.S.: The natural history of the SIRS. JAMA 273: 117-123, 1995. Yajima, Y., Noma, H., et al.: Systemic inflammatory response syndrome and postoperative complications after oral cancer surgery. Bull. Tokyo. Dent. Coll 41:187-194, 2000
Siratsuchi Y, Kuno K, Tsiro H: Evaluation of masticatory function following orthognathic surgical correction of mandibular prognathism: J.Cranio-max.-fac surg 19:299-303, 1991 Kobayashi T, Honma K, Nakajima T, Hanada K: Masticatory function in patients with mandibular prognathism before and after orthognathic surgery. J Oral Maxillofac Surg 51: 997-1001, 1993 Kobayasi T, Honma K, Singaki S, Nakajima T: Changes in masticatory function after orthognathic treatment in patients with mandibular prognathism..J.Oral maxillo-fac surg 39:260-265, 2001
POSTER 199 Changes in Masticatory Function After Surgical Orthognathic Treatment in Patients With Jaw Deformities: Efficay of Masticatory Exercise Using Chewing Gum
POSTER 200
Kensuke Kato, DDS, Japan (Kato K; Kobayasi T; Oda Y; Izumi N; Ono Y; Saito C)
Bong-Chul Kim, DDS, Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, 134 Shinchon-Dong, Seodaemoon-Gu, Seoul, 120-752, Korea (Yi CK; Jung YS)
Statement of the Problem: Recovery of masticatory function is one of the important objectives of orthognathic surgery. Materials and Methods: In the present study, changes of masticatory function after surgery and efficacy of masticatory exercise were evaluated longitudinally in 41 patients in whom jaw deformities were surgically corrected and masticatory exercise using chewing gum were conducted for five minutes two times a day for 90 days. The findings of masticatory function were compared with those of 20 control subjects with normal occlusion and those of 15 patients in whom jaw deformities were surgically corrected and masticatory exercise were not conducted. Method of Data Analysis: Masticatory efficiency was measured using ATP granules, and the number and area of occlusal contacts and maximum occlusal force were evaluated by Occlusal Prescale, and subjective feeding abilities were evaluated by questionnaires.Measurements were performed three times, namely before surgery, and six months and one year after surgery. Results: The mean masticatory efficiency in the patients with high executing rates of masticatory exercise was increased postoperatively to the same level as control group, but that in the patients with low executing rates of masticatory exercise was low and at the same level as the patients without masticatory exercise. On the other hand, improvement rates of the number and area of occlusal contacts were not correlated with executing rate of masticatory exercise. Subjective feeding abilities were considerably improved postoperatively in all patients. Conclusion: In conclusion, it is considered that masticatory exercise using chewing gum after orthognathic surgery is effective to improve maximum occlusal force and masticatory efficiency in the patient with jaw deformity and should be integrated into the treatment. 43.e112
Stability of the Maxillary Position After Le Fort I Osteotomy Using Biodegradable Plates and Screws
Statement of the Problem: In orthognathic surgery, internal fixation has usually been done with titanium plates and screws. Recently, biodegradable plates and screws have been frequently used, but any reports of the long term results of postoperative stability are rare, especially after performing maxillary repositioning with orthognathic surgery. Materials and Methods: In order to clarify the clinical utility of self-reinforced bioresorbable poly-70L/30DLLactide miniplates & screws for maxillary fixation after Le Fort I osteotomy, this study examined the postsurgical changes in the maxilla and the complications of biodegradable plates and screws. Method of Data Analysis: Nineteen patients who had undergone maxillary internal fixation using biodegradable plates and screws were evaluated both radiographically and clinically. A comparison study of the changes of the maxilla position after surgery in all 19 patients was performed via 1-week, 1-month, 3-months, 6-months and/or 1-year postoperative lateral cephalograms by tracing. Complication of the biodegradable plates and screws was evaluated by performing follow-up roentgenograms and clinical observation. One-way ANOVA testing was used for statistical analysis. Results: The position of the maxillary bone was stable after surgery and it was not significantly changed from 1 week to 1 year after the operation. We could not find any complications of biodegradable plates and screws. Conclusion: Internal fixation of the maxilla after Le Fort I osteotomy with using self-reinforced biodegradable plates and screws is a reliable method for maintaining the postoperative position of the maxilla after Le Fort I osteotomy. AAOMS • 2007
POSTER 197 Molecular and Clinical Approach in a Japanese Family With CL/P and a Balanced Translocation t (9;17)(q32; q12) Atsuo Kaetsu, DDS, PhD, Japan (Machida J; Kamamoto M; Yamamoto T; Sumiyoshi S; Moon M) Statement of the Problem: Cleft lip and/or palate (CL/P) are common birth defects of multifactorial etiology by both genetic and environmental factors (1). Recently, we found a Japanese family with a balanced translocation t(9;17)(q32;q12). Of three generations with translocation, one subject has cleft lip and palate. It has been demonstrated that facial development is associated with genes on chromosome 9q and 17q (2), leading to a possibility that genes disrupted by the translocation may play an important role in clefting. The purposes of this study are following; 1) Identification of genes underlying the breakpoints of the translocation. 2) Determine the association of the disrupted genes with the occurrence of CL/P. Here, we report a molecular genetic analysis and clinical examination of this family. Materials and Methods: A male infant was born prematurely by cesarean section at 24th gestational age after an uneventful pregnancy. His birth weight and height were 706 g and 31.8 cm, respectively. He had ocular hypertelorism, a bilateral cleft lip and palate, and a mild flat nose. His father and paternal grandmother had the same translocation of 9q32 and 17q12 as seen in the patient, while no family history of malformations. 1) We determined the breakpoints of the translocation by fluorescence in situ hybridization (FISH) analysis using BAC clones and subsequent long range PCR analysis using established lymphoblastoid cell lines. 2) In order to study the role of these candidate genes in forming a cleft, we examined clinical data and findings. Method of Data Analysis: The PCR products covering the breakpoint were analyzed on ABI 3700 automated sequencer, after the reaction with BigDye. The Applied Biosystems sequence software (version 2.1.2) was used for lane tracking. Chromatograms were transferred to a UNIX workstation, base called with PHRED 4.0 (http:// droog.mbt.washington.edu/poly_doc40.html) and results viewed with CONSED program (version 4.0) (3). The UCSC (http://genome.ucsc.edu/cgi-bin/hgGateway) database was used to detect potential genes around the breakpoint. Then, the gene function is examined by biochemical test of the patient. Results: 1) Sequence analysis demonstrated that two genes, SLC31A1 (Solute Carrier Family 31 Member 1) on AAOMS • 2007
chromosome 9 and CCL2 (Chemokine Ligand 2) on chromosome 17, were rearranged with the breaks occurring within their introns.2) Although, SLC31A1 is associated with a transportation element essential for life, copper, so far, we did not find any clinical evidence for the Copper metabolism disorder in the patient. Conclusion: Although, the present data support that genes may play an important role in facial development, it is necessary to extend an additional investigation of Copper metabolism. References Orofacial clefting: recent insights into a complex trait. Jugessur A and Murray JC; Curr Opin Genet Dev. 2005 Jun;15(3):270-8 Meta-analysis of 13 genome scans reveals multiple cleft lip/palate genes with novel loci on 9q21 and 2q32-35. Mary L. Marazita, Jeffrey C. Murray, et.al, Am J Hum Genet. 2004 August; 75(2): 161–173 PolyPhred: automating the detection and genotyping of single nucleotide substitutions using fluorescence-based resequencing. Nickerson DA, Tobe VO, Taylor SL. Nucleic Acids Res. 1997 Jul 15;25(14): 2745-51
POSTER 198 Systemic Inflammatory Response Syndrome and Postoperative Complications After Orthognathic Surgery Kiyohiro Kasahara, PhD, Japan (Kamio T; Takaki T; Uchiyama T; Takano N; Shibahara T) Statement of the Problem: The concept of “systemic inflammatory response syndrome” (or SIRS) was proposed at American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference in 1991. SIRS symptoms immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. Reports discussing the relationship between operative stress and SIRS are found in the field of digestive surgery, but not in that of oral surgery. Materials and Methods: Sixty jaw deformity cases who had undergone orthognathic surgery from September 2003 to October 2006 were involved in this study. Method of Data Analysis: We assigned 27 cases who met two of the several diagnostic criteria for SIRS and continued to meet them for at least 24 hours after surgery to the SIRS group. The other 33 patients were assigned to the non-SIRS group. Results: Postoperative complications occurred in 22.1% of the SIRS group and 0.0% of the non -SIRS group (p ⬍ 0.05). In six cases, the postoperative fluctuation of IL-6 level was evaluated. Conclusion: These results suggest the importance of careful management of postoperative SIRS patients to prevent complications. 43.e111
Scientific Poster Session References
References
Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 20 Rangel-Frausto, M.S.: The natural history of the SIRS. JAMA 273: 117-123, 1995. Yajima, Y., Noma, H., et al.: Systemic inflammatory response syndrome and postoperative complications after oral cancer surgery. Bull. Tokyo. Dent. Coll 41:187-194, 2000
Siratsuchi Y, Kuno K, Tsiro H: Evaluation of masticatory function following orthognathic surgical correction of mandibular prognathism: J.Cranio-max.-fac surg 19:299-303, 1991 Kobayashi T, Honma K, Nakajima T, Hanada K: Masticatory function in patients with mandibular prognathism before and after orthognathic surgery. J Oral Maxillofac Surg 51: 997-1001, 1993 Kobayasi T, Honma K, Singaki S, Nakajima T: Changes in masticatory function after orthognathic treatment in patients with mandibular prognathism..J.Oral maxillo-fac surg 39:260-265, 2001
POSTER 199 Changes in Masticatory Function After Surgical Orthognathic Treatment in Patients With Jaw Deformities: Efficay of Masticatory Exercise Using Chewing Gum
POSTER 200
Kensuke Kato, DDS, Japan (Kato K; Kobayasi T; Oda Y; Izumi N; Ono Y; Saito C)
Bong-Chul Kim, DDS, Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, 134 Shinchon-Dong, Seodaemoon-Gu, Seoul, 120-752, Korea (Yi CK; Jung YS)
Statement of the Problem: Recovery of masticatory function is one of the important objectives of orthognathic surgery. Materials and Methods: In the present study, changes of masticatory function after surgery and efficacy of masticatory exercise were evaluated longitudinally in 41 patients in whom jaw deformities were surgically corrected and masticatory exercise using chewing gum were conducted for five minutes two times a day for 90 days. The findings of masticatory function were compared with those of 20 control subjects with normal occlusion and those of 15 patients in whom jaw deformities were surgically corrected and masticatory exercise were not conducted. Method of Data Analysis: Masticatory efficiency was measured using ATP granules, and the number and area of occlusal contacts and maximum occlusal force were evaluated by Occlusal Prescale, and subjective feeding abilities were evaluated by questionnaires.Measurements were performed three times, namely before surgery, and six months and one year after surgery. Results: The mean masticatory efficiency in the patients with high executing rates of masticatory exercise was increased postoperatively to the same level as control group, but that in the patients with low executing rates of masticatory exercise was low and at the same level as the patients without masticatory exercise. On the other hand, improvement rates of the number and area of occlusal contacts were not correlated with executing rate of masticatory exercise. Subjective feeding abilities were considerably improved postoperatively in all patients. Conclusion: In conclusion, it is considered that masticatory exercise using chewing gum after orthognathic surgery is effective to improve maximum occlusal force and masticatory efficiency in the patient with jaw deformity and should be integrated into the treatment. 43.e112
Stability of the Maxillary Position After Le Fort I Osteotomy Using Biodegradable Plates and Screws
Statement of the Problem: In orthognathic surgery, internal fixation has usually been done with titanium plates and screws. Recently, biodegradable plates and screws have been frequently used, but any reports of the long term results of postoperative stability are rare, especially after performing maxillary repositioning with orthognathic surgery. Materials and Methods: In order to clarify the clinical utility of self-reinforced bioresorbable poly-70L/30DLLactide miniplates & screws for maxillary fixation after Le Fort I osteotomy, this study examined the postsurgical changes in the maxilla and the complications of biodegradable plates and screws. Method of Data Analysis: Nineteen patients who had undergone maxillary internal fixation using biodegradable plates and screws were evaluated both radiographically and clinically. A comparison study of the changes of the maxilla position after surgery in all 19 patients was performed via 1-week, 1-month, 3-months, 6-months and/or 1-year postoperative lateral cephalograms by tracing. Complication of the biodegradable plates and screws was evaluated by performing follow-up roentgenograms and clinical observation. One-way ANOVA testing was used for statistical analysis. Results: The position of the maxillary bone was stable after surgery and it was not significantly changed from 1 week to 1 year after the operation. We could not find any complications of biodegradable plates and screws. Conclusion: Internal fixation of the maxilla after Le Fort I osteotomy with using self-reinforced biodegradable plates and screws is a reliable method for maintaining the postoperative position of the maxilla after Le Fort I osteotomy. AAOMS • 2007