Bing Shi

Development of a method for rating nasal appearance after cleft lip repair

The aim of this study was to develop a new method for evaluation of nasal appearance in patients after cleft lip repair. A method is described in which the nasal region is evaluated without the influence of the labial repair. Frontal, submental and profile view photographs of 45 patients after cleft lip repair were obtained. For each patient, two sets of images, one of the entire nasolabial region and one of the nasal complex in isolation, were assessed with a five-point scale by a panel of seven judges. Repeat evaluation at 1 week allowed calculation and comparison of intra-judge and inter-judge reproducibility. The interclass correlation coefficient (ICC) values were higher in the assessment of the isolated nasal complex when compared to the nasolabial region with the exception of the cleft side lateral view. The ICC value of the assessment based on all three views was the highest. The level of intra-judges and inter-judges was good, thus the reliability and sensibility of this new method is acceptable. This method is credible because acceptable pooled levels of reliability were obtained. In the future, this rating system may be used to assess nasal appearance after different treatments for cleft lip patients.

The natural history of audiologic and tympanometric findings in patients with an unrepaired cleft palate.

Objective: To present the tympanometric findings in 552 patients (115 over 10 years of age) with unrepaired cleft palate (256 had audiologic findings) and to show the natural history and outcome of these cases. Setting: The cleft lip and palate clinic for the Division of Cleft Lip and Palate Surgery at the West China College of Stomatology, Sichuan University, Chengdu, Peoples Republic of China. Design: Pure-tone audiometric and tympanometric evaluations were performed on 552 patients with an unrepaired cleft palate. Results were analyzed by looking at the patients age and cleft palate type. Results: This study demonstrated an age-related decrease in the frequency of hearing impairment and abnormal tympanometry. The frequency of hearing impairment and abnormal tympanometry in patients with submucous cleft palate was significantly lower than in patients from the other four major cleft palate categories (p  =  .001, p  =  .006, respectively). Conclusions: The middle ear function and hearing levels of unrepaired cleft palate patients improved with age, but at least 30% of the patients’ ears demonstrated a hearing loss and abnormal tympanometry in each age group, including those over 19 years of age. In the crucial language-learning stage, the frequency of hearing impairment and abnormal tympanometry was as high as 60%. Considering these results, palate repair and surgical intervention, such as tube insertion, for otological problems should be considered at an early age.

A preliminary study on the teratogenesis of dexamethasone and the preventive effect of vitamin B12 on murine embryonic palatal shelf fusion in vitro

Excessive dexamethasone (Dex) administrated into pregnant mice during critical periods of palatal development can produce a high incidence of cleft palate. Its mechanisms remain unknown. Vitamin B12 has been shown to antagonize the teratogenic effects of Dex, which, however, remains controversial. In this study, we investigated the effects of Dex and vitamin B12 on murine embryonic palatal shelf fusion using organ culture of murine embryonic shelves. The explanted palatal shelves on embryonic day 14 (E14) were cultured for 24, 48, 72 or 96 h in different concentrations of Dex and/or vitamin B12. The palatal shelves were examined histologically for the morphological alterations on the medial edge epithelium (MEE) and fusion rates among different groups. It was found that the palatal shelves were not fused at 72 h or less of culture in Dex group, while they were completely fused in the control and vitamin B12-treated groups at 72 and 96 h, respectively. The MEE still existed and proliferated. In Dex+vitamin B12 group the palatal shelves were fused at each time point in a similar rate to controls. These results may suggest that Dex causes teratogenesis of murine embryonic palatal shelves and vitamin B12 prevents the teratogenic effect of Dex on palatogenesis on murine embryos in vitro.

A geometrically justified rotation advancement technique for the repair of complete unilateral cleft lip

A modification of the Millard rotation advancement technique for repair of complete unilateral cleft lip has been used in our medical centre for the past six years. We developed this geometrically justified technique based on our experience treating many patients in our department. Based on the analysis of pre- and postoperative face casts of each patient, as well as based on the comparison between patients and controls, we found that our technique achieved excellent cosmetic results, giving a natural-looking lip.

Evaluation of facial growth in non-cleft patients using the analysis method for patients after a cleft lip and/or palate repair ☆

Analysis of the soft tissue profile is recognized as an important aspect for assessing the effect of different surgical methods in patients with a cleft lip and/or palate. Two hundred seventy healthy people with deciduous, mixed and permanent dentition were chosen for photographs. The photographs were measured and the ratios were calculated using the aesthetic indexes of the nasal and lip region used for evaluating cleft lip and palate repairs. Results revealed six measurements were symmetrical in non-cleft patients and the range of ratios was from 99.8% to 106.88%. This study indicated that the indexes were important for evaluation of cleft lip and palate repair. Based on the above results it was concluded that surgery was successful if the ratio was less than 10% when compared to non-cleft patients.

110 infants with unrepaired unilateral cleft lip: An anthropometric analysis of the lip and nasal deformities

The aim of this retrospective study was to correlate the width of the cleft lip with the severity of the nasal deformity in unilateral cleft lip and palate (UCLP) patients before primary lip repair. Preoperative impression casts were made. Measurements were taken of the width of the cleft lip (CW), nose (NW), and nasal floor (NFW), alar base height (ABH), columella length (CL), nasal length (NL) and nasal tip protrusion (NTP). The ratio of the non-cleft side (NFW) to the cleft side (NFWR), the ratio of the non-cleft side (ABH) to the cleft side (ABHR), and the ratio of the cleft side (CL) to the non-cleft side (CLR) were calculated. The average NW, NL and CW were higher in the group with complete clefts. There was a negative linear relationship between CW and NFWR, and a positive linear relationship between CW and ABHR in the complete group. In the incomplete group, negative correlations were obtained between CW and NFWR and between CW and ABHR. These findings show that there are correlations between CW and the transverse and vertical imbalance of nose in both groups but not between CW and anteroposterior imbalance of nose.

Animal experimental study on repairing alveolar clefts by using rectilinear distraction osteogenesis.

The aim of this study was to evaluate the clinical applicability of rectilinear distraction osteogenesis for repairing alveolar cleft models. Alveolar process distraction surgery to produce bilateral clefts was performed on six adult cats. In our study, the left side with the distraction device was the experimental side, and the other side without a distraction device was the control side. After a 6-day latent period, animals underwent gradual distraction at a rate of 0.6mm per day (distraction was performed twice each day, at a rate of 0.3mm each time), until the tissue on the two sides of the cleft touched, then the distraction strength was maintained for 2 days. Two cats were sacrificed at 2 weeks, 6 weeks and 10 weeks postoperatively. Gross anatomical, histological and radiographical analyses were performed after the animals were sacrificed. In addition, the arch width was measured both before setting the distraction device and after distraction was complete. Two weeks after the distraction was complete, the soft tissue of the two sides of the cleft region on the experimental side touched, and it began to coalesce. The extremities of the two sides of the cleft region on all the experimental sides drew close to each other, but there was no bony conjunction. New bone formation appeared in the distraction region. The arch width at the front of the maxillary bone on the distraction side after distraction was smaller than before distraction. The alveolar cleft could be closed by rectilinear distraction osteogenesis. Two sides of the cleft touched each other and only soft tissue coalesced, but we did not observe bone coalescing. This phenomenon suggested that it might be difficult to achieve complete bony repair by rectilinear distraction osteogenesis. However, rectilinear distraction osteogenesis can minimise the size of the alveolar cleft and make bone grafting advisable for those patients who are not suitable for bone grafting before distraction osteogenesis.

Is it possible to antagonize 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin- induced cleft palate by prenatal administration of folic acid? An experimental study:

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) can cause a high percentage of cleft palate in fetuses when administered during organogenesis in certain strains of mice including C57BL/6J. In this study, folic acid (FA) was tested for antiteratogenic effects on TCDD-induced cleft palate in fetal mice. The pregnant C57BL/6J mice were dosed with 24 µg TCDD/kg and/or 5 mg, 10 mg, 20 mg, 40 mg FA/kg body weight on gestation day (GD) 10. The control group mice received 50 mL sesame oil/kg body weight on GD10. The mice were sacrificed on GD12.5, GD13.5, GD14.5, GD15.5, and GD16.5. The harvested embryos were examined to detect the incidence of cleft palate and the developing palatal shelves on different phases were investigated morphologically and histologically among different groups. Total frequency of clefts was 55.56% in TCDD group and 17.50% (5 mg), 42.85% (10 mg), 42.10% (20 mg), 28.26% (40 mg) in TCDD + FA groups. FA (5 mg) reduced the incidence of the cleft palate from 55.56% to 17.50% (p = 0.005). There were no significant differences between the TCDD group and 10 mg, 20 mg, 40 mg TCDD + FA groups. Based on the these results, the present study suggests that FA can reduce the incidence of 2,3,7,8-TCDD-indued cleft palate in mice.

A preliminary study on the hard-soft tissue relationships among unoperated secondary unilateral cleft nose deformities

OBJECTIVE The aim of this study was to explore the bone-soft tissue relationships around the nasolabial area in uncorrected secondary unilateral cleft nose deformities. STUDY DESIGN Measurements taken from photographs and cone-beam computerized tomography (CBCT) results were derived and paired up to represent the deformity features of bone and soft tissue, respectively. RESULTS All soft tissue measurements were significantly smaller than the corresponding bone measurements. Various bone-soft tissue correlation patterns were observed in different measurement pairs. CONCLUSIONS The adopted photography-CBCT combined measurement method appeared to be reliable in evaluating the hard-soft tissue relationships in the nasolabial area. In unoperated unilateral cleft nose deformities, bony deformities would decide the soft tissue contours, and soft tissue in turn could camouflage the underlying bone deformities in various patterns and scale, making the external configuration less deformed than its bone basis.

A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients

Alveolar bone graft is considered conducive to tooth eruption and maxilla stability in unilateral cleft patients, but its contribution to nasal symmetry is still under discussion. To explore the detailed effects of alveolar bone graft on nasal symmetry and its role in rhinoplasty, 90 mixed-dentition complete unilateral cleft lip and palate patients were studied and categorised according to the operation they underwent during the mixed dentition period (bone graft, secondary rhinoplasty or bone graft and rhinoplasty combined). Standardised frontal and submental oblique photographs were taken before and after surgery, and objective measurements for the evaluation of nasal symmetry were devised. Measurement reliability was examined with the intraclass correlation coefficient. Intra- and inter-group comparisons were performed to explore the effect of bone graft on nasal symmetry and its role in rhinoplasty. The intraclass correlation coefficient values were >0.84. Preoperative inter-group analysis yielded satisfactory comparability. Among the bone-graft-only patients, seven of 10 measurements demonstrated significant differences, five indicated enhanced symmetry and two indicated compromised symmetry. For the rhinoplasty-only patients, all measurements revealed significant improvement. Compared with the patients who underwent rhinoplasty only, those who underwent combined bone graft and rhinoplasty were superior in nasal-base elevation only. The photogrammetric strategy appeared reliable for evaluation of nasal symmetry. Most of the effects imposed by alveolar bone graft on nasal symmetry were localised to the alar base and would be camouflaged by rhinoplasty. Considering the limited benefit in symmetry and the potential risk of more complications, overextended dissection during mixed dentition bone graft may be unnecessary.