Dror Aizenbud

Cigarette smoking and inflammation revisited.

Despite the significant health risks resulting from tobacco use, the prevalence of smokers worldwide remains high. Cigarette smoking is one of the major sources of toxic chemical exposure to humans and is the greatest cause of preventable illnesses and premature death. The adverse consequences of smoking in various pathologies are mediated by its effects on the immune-inflammatory system. In this review, we aim to explore the effects of cigarette smoking on the inflammatory response and molecular mechanisms with emphasis on the nuclear factor kappa B (NF-kB) pathway. The effects of smoking on various inflammatory pathologies will be discussed, focusing on oral diseases, airway inflammation, chronic obstructive pulmonary disease (COPD) and inflammatory bowel diseases (IBD).

Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palate patients

Fourteen children, aged 8 to 13 years, with unilateral or bilateral cleft lip and palate, were treated by an incomplete Le Fort I osteotomy without down-fracturing the maxilla, followed by traction of the maxilla by face mask for twelve weeks. Our results revealed a mean maxillary forward movement of 7.2 mm after three weeks of traction, followed by a retention period of nine weeks for callus maturation. There was an associated minor downward movement of the maxilla that caused a slight increase in the lower facial height, which improved the facial esthetics of the patients. The advantages of this method are: i) it allows for early skeletal advancement of the maxilla with new bone formation in the osteotomy line, ii) there is no need for inter-maxillary fixation of young patients and no need for rigid fixation of the maxilla by miniplates that can damage teeth buds and roots at this age, and iii) it can be used in young patients to improve esthetic appearance, an important factor in the psychological development of adolescents.

Congenitally missing teeth in the Israeli cleft population.

Objective The purpose of the study was to determine the prevalence of congenitally missing teeth in a group of Israeli children with various types of clefts. Design Prevalence of congenitally missing teeth was determined for 179 children with cleft lip, cleft lip and alveolar ridge, cleft lip and palate, and cleft palate. Subgroupings were assessed according to patient sex, origin, cleft type, tooth type, and the side of hypodontia. The diagnosis of congenitally missing teeth (CMT) was based on initial and follow-up panoramic roentgenograms. In case of doubt, occlusal or periapical roentgenograms as well as clinical dental photographs were also used. Setting Data collection was conducted at the Rambam Medical Center, Orthodontic and Craniofacial Unit, Haifa, Israel. Results In the total cleft group, 67.6% of the patients presented with hypodontia, totaling 246 missing teeth. A statistically significant difference was found in the distribution of patients with CMT of Jewish and minority origin according to sex. Cleft lip and palate was the most frequently affected group in which 195 teeth were missing. The most frequently missing tooth among the cleft population was the maxillary incisor. The order of frequency of the other missing teeth was the same as in the normal population. Hypodontia and malformations of permanent teeth were most common on the cleft side. Conclusion The frequency of CMT in the Israeli cleft population studied was higher than in the intact population. This confirms findings in other populations worldwide.

Lifestyle and Sarcopenia—Etiology, Prevention, and Treatment

The term sarcopenia describes the loss of skeletal muscle mass, strength, and function in old age. As the world population continues to grow older, more attention is given to the phenomena of sarcopenia and the search for strategies of prevention and treatment. The progression of sarcopenia is affected by age-related physiological and systemic changes in the body, including alterations in skeletal muscle tissue, hormonal changes, increased inflammatory activities, and oxidative stress. Sarcopenia progression is also affected by lifestyle factors which are far more controllable. These factors include various aspects of nutrition, physical activity, exercise, alcohol intake, and tobacco use. Raising the public awareness regarding the impact of these factors, as causes of sarcopenia and potential strategies of prevention and treatment, is of great importance. In this review we aim to describe various lifestyle factors that affect the etiology, prevention, and treatment of sarcopenia.

Airway analysis: with bilateral distraction of the infant mandible.

Background: Mandibular distraction was proven to be a valuable tool for lengthening the hypoplastic mandible and relieving airway obstruction in infants. However, analysis of presurgical and postsurgical three-dimensional computed tomography and polysomnogram studies is lacking. The aim of this study was to describe the effect of distraction on the airway by evaluating the clinical, three-dimensional radiographic and polysomnogram studies before and after distraction. Methods: Seventeen infants with micrognathia who underwent internal curvilinear mandibular distraction from April 2005 through April 2008 at Lucile Packard Childrens Hospital were included. Preoperative and postoperative computed tomography, polysomnograms, and feeding evaluations were obtained and compared after distraction. Results: The mean patient age before surgery was 105 days. All patients tolerated the distraction process with a mean mandibular advancement of 18.1 mm. One patient experienced a temporary marginal mandibular nerve palsy that resolved, and 1 postoperative wound infection was encountered. Preoperatively, the mean retroglossal oropharyngeal cross-sectional area was 41.53 mm2. This was associated with a mean preoperative apnea-hypopnea index (AHI) of 10.57 and a minimum oxygen desaturation of 83%. After distraction, the mean airway increased to 127.77 mm2. All patients had clinical improvement of their respiratory status; the mean postoperative AHI was 2.21, and the minimum oxygen desaturation was 90%. The result was a 209% cross-sectional airway increase. All patients progressed to oral feeds by 3.5 months postoperatively. Conclusions: Mandibular distraction is effective at relieving anatomic airway obstruction in infants with micrognathia and obstructive sleep apnea while avoiding some previously reported associated complications.

The management of mandibular body fractures in young children

This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.

Sarcopenia and smoking: a possible cellular model of cigarette smoke effects on muscle protein breakdown

Sarcopenia, the age‐related loss of muscle mass and strength, is a multifactorial impaired state of health. Lifestyle habits such as physical activity and nutrition have a major impact on sarcopenia progression. Several epidemiological studies have also shown an association between cigarette smoking and increased levels of sarcopenia in elderly long‐time smokers. Clinical, in vivo, and in vitro studies have tried to investigate the mechanism behind exposure to cigarette smoke (CS) and the subsequent effects on skeletal muscles. The aim of this review is to present a cellular model of CS‐induced skeletal muscle protein breakdown based on recent studies dealing with this issue and to propose new potential research directions that may explain the effects of exposure to CS on skeletal muscle integrity.

Distraction osteogenesis in maxillary deficiency using a rigid external distraction device.

Distraction osteogenesis is an effective method of bone regeneration. McCarthy et al.1 were the first to report success in human mandible lengthening using distraction osteogenesis. The primary cleft lip and palate repair performed during infancy and early childhood improves the facial appearance, speech, and deglutition, but these early surgical interventions cause an impairment of maxillary growth, producing secondary deformities of the jaw and malocclusion.2,3 The hypoplastic maxilla can be advanced later by Le Fort I osteotomy, with or without bone graft, to re-establish the facial balance and occlusion.4–6 However, the maxilla in these patients is often difficult to mobilize because of the scarring from previous operations. Despite improvements in surgical fixation, there is greater tendency to relapse in cleft patients compared with noncleft patients with maxillary hypoplasia.4,7,8 Patients with severe cleft maxillary deficiency are difficult to treat with standard surgical orthognathic surgery. Treatment of severe maxillary hypoplasia with conventional Le Fort I maxillary advancement, especially in patients with orofacial cleft, has been unstable. The extreme discrepancies between the bony segments make stabilization difficult, and the added effect of palatal scarring can result in significant postsurgical relapse. Maxillary distraction is believed to be especially effective for cleft lip and palate patients with severe maxillary hypoplasia.9–11 Maxillary advancement may benefit articulation, but it compromises velopharyngeal closure by increasing the nasopharyngeal distance. It is known that velopharyngeal closure could be compromised after conventional maxillary advancement (not maxillary distraction) exceeding 10 mm.12–14 The purpose of this study was to present our experience in the treatment of maxillary deficiency in cleft patients using rigid external distraction devices. Patients received 2 years of clinical and cephalometric follow-up, and preoperative and postoperative changes in velopharyngeal function in cleft lip and palate patients were evaluated. In this article, we discuss the advantages of distraction osteogenesis for the treatment of major maxillary deficiency in cleft patients compared with the conventional Le Fort I advancement, in terms of stability and relapse and postoperative changes in velopharyngeal function.

Distraction osteogenesis for tracheostomy dependent children with severe micrognathia.

AbstractObstructive sleep apnea (OSA) in pediatric populations is often associated with congenital craniofacial malformations resulting in decreased pharyngeal airway, which in severe cases leads to tracheostomy dependence. The purpose of this study was to use distraction osteogenesis to improve the airway and decannulate the tracheostomy. This study involved 11 OSA tracheostomy-dependent patients (age range, 4 months to 6 years) who underwent bilateral distraction in the mandibular body using extraoral distraction devices. Following a latency period of 4 days, gradual distraction at a rate of 1 mm/d was performed followed by a consolidation period of 10 weeks. Three-dimensional computed tomography reconstruction of the face and neck before and after the mandibular lengthening aided in quantitative volumetric evaluation of mandibular volume and airway volume. The results demonstrated mandibular elongation of a mean of 30 mm on each side, an increase in mandibular volume by an average of 29.19%, and increase in pharyngeal airway by an average of 70.53%. Two to 3 months following the last lengthening, all 11 patients were decannulated with improvement of signs and symptoms of OSA and elimination of oxygen requirement. Mean follow-up was 2.0 years. The oxygen saturation level rose to more than 95%, and the apnea index respiratory disturbance index was less than 2 episodes per hour for all patients. Bilateral mandibular distraction is a useful method in younger children to decannulate permanent tracheostomy expanding the hypoplastic mandible and concomitantly advance the base of tongue and hyoid bone increasing the pharyngeal airway.

Salivary analysis and antioxidants in cleft lip and palate children.

OBJECTIVE To investigate the sialometry, sialochemistry and antioxidants in cleft patients prior to alveolar closure procedures. DESIGN Saliva was collected from 21 children with unilateral and bilateral cleft lip and palate (UCLP and BCLP) with overt oronasal alveolar communication and with recurrent licking of fluids and soft diet complaints (the study group) and in 22 normal individuals (the control group). Salivary flow rate was measured, and calcium (Ca), phosphate (P), magnesium (Mg), total protein, albumin, amylase, lactate dehydrogenase (LDH), and secretory IgA were analysed. Salivary total antioxidant status (TAS), peroxidase activity, superoxide dismutase (SOD) activity, uric acid (UA), was also determined. RESULTS The sialometry and sialochemistry analyses did not reveal significant difference between the two groups. Salivary median uric acid concentration was 6-fold lower in the cleft group (p<0.05). The median total antioxidant status (TAS) of the cleft group however, was significantly higher by 58% (p<0.005) than that of the control group. Median SOD activity was also higher in the cleft group, by 42%, though these differences did not reach statistical significance. CONCLUSIONS Our findings suggest that the oral biology system of cleft patients in their prealveolar closure stage does not differ significantly from normal controls. Low UA found in the saliva of cleft patients may suggest that some genetic alteration of the UA transport occurs simultaneously when cleft lip and palate occur. TAS reduction may also reveal an increased oxidative stress burden in the oral cavities of cleft children which has never been shown before.