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Craniosynostosis is a relatively common birth defect characterized by the premature fusion of one or more cranial sutures. Examples of craniosynostosis syndromes include Crouzon (CS), Pfeiffer (PS), and Apert (AS) syndrome, with clinical characteristics such as midface hypoplasia, hypertelorism, and in some cases, limb defects. Mutations in Fibroblast Growth Factor Receptor-2 comprise the majority of known mutations in syndromic forms of craniosynostosis. A number of clinical reports of FGFR-associated craniosynostosis patients and mouse mutants have been linked to gastrointestinal tract (GIT) disorders, leading to the hypothesis of a direct link between FGFR-associated craniosynostosis syndromes and GIT malformations. We conducted an investigation to determine GIT symptoms in a sample of FGFR-associated craniosynostosis syndrome patients and a mouse model of CS containing a mutation (W290R) in Fgfr2. We found that, compared to the general population, the incidence of intestinal/bowel malrotation (IM) was present at a higher level in our sample population of patients with FGFR-associated craniosynostosis syndromes. We also showed that the mouse model of CS had an increased incidence of cecal displacement, suggestive of IM. These findings suggest a direct relationship between FGFR-related craniosynostosis syndromes and GIT malformations. Our study may shed further light on the potential widespread impact FGFR mutations on different developmental systems. Based on reports of GIT malformations in children with craniosynostosis syndromes and substantiation with our animal model, GIT malformations should be considered in any child with an FGFR2-associated craniosynostosis syndrome. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Wound catheter infusion (WCI) with local anesthetics (LA) is a regional anesthesia technique, which has shown to produce effective postoperative analgesia in adults, without any adverse effects on wound healing. To investigate the efficacy and safety of WCI with LA for the treatment of postoperative pain in children, we conducted a systematic review of literature published until 2020. The literature search included articles concerning subcutaneous WCI with LA, in the surgical wound, as treatment of postoperative pain, in children <18 years of age. Exclusion criteria were studies describing peripheral nerve blocks, intercostal, abdominal or thoracic wall blocks and single local anesthetic infiltration of the surgical wound. The articles were appraised for quality and only randomized controlled trials with a Jadad score ≥3 were included for evaluation of results concerning postoperative pain scores and opioid use. All relevant original studies, including observational studies and case reports, were assessed for adverse events and measurements of LA plasma concentrations during WCI. A total of 1907 articles were found, leading to 92 relevant abstracts selected for further review. After exclusion of articles of which full texts could not be retrieved or because of exclusion criteria, 28 articles remained. Thirteen articles described randomized controlled trials, of which 10 were assessed as good or excellent in quality. Due to the small number and heterogeneity of the studies, the data could not be pooled. Instead, results were described per type of procedure: abdominal surgery, extremity surgery, thoracic surgery and iliac crest bone harvesting. Reduced pain scores and opioid needs were demonstrated after abdominal and extremity surgery. In five studies, plasma levels of LA were measured, which all remained below toxic thresholds. In all relevant studies, no serious adverse events concerning the use of WCI were reported. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Tuberous sclerosis (TSC) is an autosomal dominant neurocutaneous disorder. This case highlights rare isolated neurologic finding in a TSC patient emphasizing the need for heightened suspicion even in the absence of any cutaneous findings and family history. [ABSTRACT FROM AUTHOR]

Purpose: Simulation course serves as an efficient supplement to the experiential learning inside the operation room in surgical residency programs. Furlow double-opposing Z-plasty (DOZ) remains an important and challenging surgical technique in cleft palate repair, but the simulation is currently limited. This study aims to develop a blended learning module with low-cost and easy-to-promote DOZ simulation., Methods: Comparison among the common rodent experimental animals and the readily available porcine tongue was made to select the ideal animal for surgical simulation, with which a DOZ learning module was developed. Oral surgery residents were enrolled to attend the blended learning module. An after-session questionnaire and a quiz were distributed to the participants to collect their feedback of the course perceptions and to assess their learning outcomes., Results: The porcine tongue had more advantages in simulating the human soft palate over the common experimental animals. The surgical procedure of DOZ could be well designed and simulated on the porcine tongue. The vast majority of the participant liked the learning module regarded it as beneficial for the comprehension if DOZ principles and procedures. With the help of the porcine tongue simulator, the blended learning module helped the participants grasp the designing principles of DOZ procedure and promote their associative learning., Conclusions: The blended learning module incorporating the porcine tongue simulator can help oral surgery residents master the principles and procedures of DOZ palatoplasty., (© 2022 American Dental Education Association.)

Key Clinical Message: Parry–Romberg syndrome is characterized by progressive dystrophy in one half of the face, which usually begins in childhood. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance. Parry–Romberg syndrome is characterized by progressive dystrophy or loss of subcutaneous tissue in one half of the face, which usually begins in childhood and continues with skin changes, and can also be associated with linear scleroderma. Although this disease has been known for more than 150 years, its exact cause and pathogenesis are not well understood. The clinical feature of Parry–Romberg syndrome that makes it possible to diagnose is unilateral idiopathic facial atrophy. The reported case is a 14‐year‐old boy who suffered from hemifacial atrophy of the frontal area since he was 7 years old was referred to a plastic and cosmetic surgery specialist and underwent surgery without systemic symptoms and in the inactive phase of the disease. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely and appropriate surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance. [ABSTRACT FROM AUTHOR]

Background: The assessment of skin aging through skin measurements faces limitations, making perceived age evaluation a more valuable and direct tool for assessing skin aging. Given that the aging process markedly affects the appearance of the eye contour, characterizing the eye region could be beneficial for perceived age assessment. This study aimed to analyze age‐correlated changes in the eye contour within the Chinese Han female population and to develop, validate, and apply a multiple linear regression model for predicting perceived age. Materials and methods: A naïve panel of 107 Chinese women assessed the perceived ages of 212 Chinese Han women. Instrumental analysis evaluated periorbital parameters, including palpebral fissure width (PFW), palpebral fissure height (PFH), acclivity of palpebral fissure (AX), angle of inner canthal (AEN), and angle of outer canthal (AEX). These parameters were used to construct a multiple linear regression model for predicting the perceived ages of Chinese Han women. A combined treatment using Fotona 4D and an anti‐aging eye cream, formulated with plant extracts, peptides, and antioxidants, was conducted to verify the cream's anti‐aging efficacy and safety. This eye cream was then tested in a large‐scale clinical trial involving 101 participants. The prediction model was employed in this trial to assess the perceived ages of the women after an 8‐week application of the eye cream. Results: All parameters were observed to decrease with age. An intergroup comparison indicated that eyelid aging in Chinese Han women accelerates beyond the age of 50. Consequently, a linear regression model was constructed and validated, with the perceived age being calculated as 183.159 ‐ 1.078 * AEN ‐ 4.487 * PFW + 6.061 * PFH ‐ 1.003 * AX ‐ 0.328 * AEX. The anti‐aging efficacy and safety of the eye cream were confirmed through combined treatment with Fotona 4D, showing improvements in wrinkles, elasticity, and dark circles under the eyes. In a large‐scale clinical evaluation using this eye cream, a perceived age prediction model was applied, suggesting that 8 weeks of use made participants appear 2.25 years younger. Conclusion: Our study developed and validated a multiple linear regression model to predict the perceived age of Chinese Han women. This model was successfully utilized in a large‐scale clinical evaluation of anti‐aging eye cream, revealing that 8 weeks of usage made participants appear 2.25 years younger. This method effectively bridges the gap between clinical research and consumer perceptions, explores the complex factors influencing perceived age, and aims to improve anti‐aging formulations. [ABSTRACT FROM AUTHOR]

The meta‐analysis aims to assess and compare the effect of tobacco usage on surgical site wound problems (SSWPs) after primary total hip and total knee arthroplasty (PTH&TKA). Using dichotomous random‐ or fixed‐effects models, the outcomes of this meta‐analysis were examined, and the odds ratio (OR) with 95% confidence intervals (CIs) was computed. Fifteen studies from 2001 to 2023 were enrolled for the present meta‐analysis including 560 819 personals with PTH&TKA. Smokers had significantly higher SSWPs (OR, 1.53; 95% CI, 1.21–1.94, p < 0.001) compared with non‐smokers in personals with PTH&TKA. Current smokers had significantly higher SSWPs (OR, 1.59; 95% CI, 1.40–1.80, p < 0.001) compared with non‐smokers in personals with PTH&TKA. Current smokers had significantly higher SSWPs (OR, 1.42; 95% CI, 1.19–1.70, p < 0.001) compared with former smokers in personals with PTH&TKA. However, former smokers and non‐smokers had no significant difference in SSWPs (OR, 1.11; 95% CI, 0.95–1.30, p = 19) in personals with PTH&TKA. The examined data revealed that in personals with PTH&TKA smokers had significantly higher SSWPs compared with non‐smokers, and current smokers had significantly higher SSWPs compared with non‐smokers and former smokers; however, former smokers and non‐smokers had no significant difference in SSWPs. Yet, attention should be implemented while relating to its values since some of the comparisons were made using a low number of selected studies. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of low luminance on face recognition, specifically facial identity discrimination (FID) and facial expression recognition (FER), in adults with central vision loss (CVL) and peripheral vision loss (PVL) and to explore the association between clinical vision measures and low luminance FID and FER. Methods: Participants included 33 adults with CVL, 17 with PVL and 20 controls. FID and FER were assessed under photopic and low luminance conditions. For the FID task, 12 sets of three faces with neutral expressions were presented and participants asked to indicate the odd‐face‐out. For FER, 12 single faces were presented and participants asked to name the expression (neutral, happy or angry). Photopic and low luminance visual acuity (VA) and contrast sensitivity (CS) were recorded for all participants and for the PVL group, Humphrey Field Analyzer (HFA) 24‐2 mean deviation (MD). Results: FID accuracy in CVL, and to a lesser extent PVL, was reduced under low compared with photopic luminance (mean reduction 20% and 8% respectively; p < 0.001). FER accuracy was reduced only in CVL (mean reduction 25%; p < 0.001). For both CVL and PVL, low luminance and photopic VA and CS were moderately to strongly correlated with low luminance FID (ρ = 0.61–0.77, p < 0.05). For PVL, better eye HFA 24‐2 MD was moderately correlated with low luminance FID (ρ = 0.54, p = 0.02). Results were similar for low luminance FER. Together, photopic VA and CS explained 75% of the variance in low luminance FID, and photopic VA explained 61% of the variance in low luminance FER. Low luminance vision measures explained little additional variance. Conclusion: Low luminance significantly reduced face recognition, particularly for adults with CVL. Worse VA and CS were associated with reduced face recognition. Clinically, photopic VA is a good predictor of face recognition under low luminance conditions. [ABSTRACT FROM AUTHOR]

Objective: Individuals born with cleft lip and palate may face difficulties in speech function, nutrition, facial aesthetics, and long‐term care. These difficulties may increase the risk of psychological and psychiatric diseases. This work aimed to test if the variant allele of COMT was carried more frequently among individuals that have psychological and psychiatric outcomes within a cohort of patients born with cleft lip and palate. Method: DNA extraction from saliva of two hundred and fifteen individuals born with cleft lip with and/or palate and genotyping was performed, and the frequency of COMT rs4818 alleles was determined. The domain 'Psychological Function' of Cleft‐Q™ was used to generate scores for analysis. The scores were computed, and differences in genotype or allele frequencies between individuals with psychological function scores 60 or above and 59 or below were compared. The history of psychiatric illness (family history of psychiatric disease or self‐reported psychiatric illness) was registered. Results: Genotype and allele frequencies were compared between individuals with and without a family history of psychiatric illness. Individuals with lower Psychological Function (Cleft‐Q™) scores were more likely to be GG (P =.04) or carriers of allele G (P <.001). The reported psychiatric illness and positive family history of psychiatric illness were compared to COMT rs4818 allele and genotype frequencies of individuals without these indicators, and individuals with psychiatric illness and positive family history of psychiatric illness were more likely to carry allele G (P =.03 and P =.008, respectively). Conclusion: The study confirms previously suggested role of COMT rs4818 in psychiatric and psychological outcomes in a distinct cohort of patients born with cleft lip and palate. [ABSTRACT FROM AUTHOR]

Objective: To assess differences based on gender in nuclear area (NA), cytoplasmic area (CA), and nuclear‐cytoplasmic ratio (N:C ratio) values for clinically normal buccal smears in apparently healthy subjects of a South Indian population, thereby providing definitive baseline cytomorphometric measurements for the South Indian population. Methods: Buccal smears were collected from 60 healthy subjects (30 males and 30 females) of a South Indian population above 18 years in age. Values of the NA and CA were measured, and the N:C ratio calculated, using ImageJ software. Statistical analysis of the data with independent t tests and 95% confidence intervals was done using SPSS version 21 (significance set at P < 0.05). Results: The results showed that there were significant differences in the NA, CA, and N:C values between males and females irrespective of age (P = 0.01). Conclusion: Definitive gender‐specific baseline cytomorphometric data can be established using exfoliative cytology for the South Indian population, and this may be helpful in deciphering the occurrence of oral pre‐malignant diseases and oral squamous cell carcinoma in this population, as the incidence of these conditions varies with gender and different ethnic groups. [ABSTRACT FROM AUTHOR]

The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present consensus provides an update to the 2017 European Dermatology Forum Guidelines, focusing on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, updated strategies for the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 1 of this consensus provides clinicians with an overview of the diagnosis and treatment of localized scleroderma (morphea), and systemic sclerosis including overlap syndromes., (© 2024 European Academy of Dermatology and Venereology.)

Background: The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment. Aims: The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices. Patients/Methods: In support of clinicians who wish to serve a diverse patient population, a 6‐part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. Results: The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for commonly treated areas in this population (forehead, infraorbital area, and jawline). Conclusions: Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether prolonged operative time is negatively associated with post‐operative complications and length of stay in patients undergoing microvascular free flap reconstruction for complex head and neck defects. Methods: 342 consecutive patients undergoing microvascular reconstruction for head and neck defects between 2017–2019 at a single institution were evaluated. Operative outcomes and operative time were compared whilst controlling for patient and treatment related factors. Results: Mean operative time was 551 min and length of stay was 16.2 days. An 11% increase in the risk of a post‐operative complication was observed for every additional hour of operative time (OR 1.11, 95% CI 1.03–1.21, p = 0.011) after adjusting for patient and treatment factors. A cut‐off of 9 h yielded a 92% increase in complications on either side of this (OR 1.92, 95% CI 1.18–3.13, p = 0.009). Increased operative time was also associated with increased length of stay and return to theatres, but not medical complications. Conclusion: Prolonged operative time is significantly associated with increased surgical complications, length of stay and return to theatres when performing microvascular reconstructive surgery for head and neck defects. [ABSTRACT FROM AUTHOR]

Background: Routinely delineating of important skeletal growth centers is imperative to mitigate radiation‐induced growth abnormalities for pediatric cancer patients treated with radiotherapy. However, it is hindered by several practical problems, including difficult identification, time consumption, and inter‐practitioner variability. Purpose: The goal of this study was to construct and evaluate a novel Triplet‐Attention U‐Net (TAU‐Net)‐based auto‐segmentation model for important skeletal growth centers in childhood cancer radiotherapy, concentrating on the accuracy and time efficiency. Methods: A total of 107 childhood cancer patients fulfilled the eligibility criteria were enrolled in the training cohort (N = 80) and test cohort (N = 27). The craniofacial growth plates, shoulder growth centers, and pelvic ossification centers, with a total of 19 structures in the three groups, were manually delineated by two experienced radiation oncologists on axial, coronal, and sagittal computed tomography images. Modified from U‐Net, the proposed TAU‐Net has one main branch and two bypass branches, receiving semantic information of three adjacent slices to predict the target structure. With supervised deep learning, the skeletal growth centers contouring of each group was generated by three different auto‐segmentation models: U‐Net, V‐Net, and the proposed TAU‐Net. Dice similarity coefficient (DSC) and Hausdorff distance 95% (HD95) were used to evaluate the accuracy of three auto‐segmentation models. The time spent on performing manual tasks and manually correcting auto‐contouring generated by TAU‐Net was recorded. The paired t‐test was used to compare the statistical differences in delineation quality and time efficiency. Results: Among the three groups, including craniofacial growth plates, shoulder growth centers, and pelvic ossification centers groups, TAU‐Net had demonstrated highly acceptable performance (the average DSC = 0.77, 0.87, and 0.83 for each group; the average HD95 = 2.28, 2.07, and 2.86 mm for each group). In the overall evaluation of 19 regions of interest (ROIs) in the test cohort, TAU‐Net had an overwhelming advantage over U‐Net (63.2% ROIs in DSC and 31.6% ROIs in HD95, p = 0.001–0.042) and V‐Net (94.7% ROIs in DSC and 36.8% ROIs in HD95, p = 0.001–0.040). With an average time of 52.2 min for manual delineation, the average time saved to adjust TAU‐Net‐generated contours was 37.6 min (p < 0.001), a 72% reduction. Conclusions: Deep learning–based models have presented enormous potential for the auto‐segmentation of important growth centers in pediatric skeleton, where the proposed TAU‐Net outperformed the U‐Net and V‐Net in geometrical precision for the majority status. [ABSTRACT FROM AUTHOR]

Treacher Collins syndrome (TCS) is one of the rare genetic syndromes which is specified by symmetrical craniofacial dysmorphism without growth abnormalities or neurological disorders. The inheritance is usually autosomal dominant but sometimes it is a sporadic mutation. Prenatal diagnosis could be realized by genetic testing of a chorionic villus sample or amniocentesis if one of the parents is affected. At birth, the most common features are downward‐sloping palpebral clefts, small badly hemmed and folded ears, and mandibular hypoplasia which could lead to respiratory distress. All of these clinical features exist in our case. Goldenhar syndrome shares with TCS some facial features which are not symmetrical and it is also associated with vertebral abnormalities. Some patients with TCS are exposed to many complications and they require multi‐disciplinary medical care. But all of them need psychiatric care to fight social rejection. The aim of our report is to describe the most common features of TCS and similar syndromes. Also, report the involved genetic mutations, some associated complications, and their management. Faced with facial dysmorphism, the clinician should describe clearly the features in order to be oriented to the diagnosis. Some explorations in particular the genetic study and specialized clinical examination are necessary to: confirm diagnosis, reveal complications, and make easier its management and follow‐up. [ABSTRACT FROM AUTHOR]

Three‐dimensional (3D) printing technology continues to develop at a rapid pace, with the potential to revolutionise multiple industries and fields including medicine. Oral and maxillofacial surgeons are particularly well placed to advance and integrate this technology into practice. This review provides a summary of 3D printing and discusses the current and future applications of this technology in oral and maxillofacial surgery, including the production of surgical planning models, training tools, cutting guides and personalised implants. While early research is promising, there still remains a paucity of large‐scale, well‐controlled clinical studies supporting the use of 3D printing technologies for many of these applications. There are also a number of other technical and regulatory challenges which will need to be addressed as this technology is taken up more widely. [ABSTRACT FROM AUTHOR]

Cleft lip and/or palate (CL/P), the most prevalent congenital anomaly, is understood to negatively affect a wide range of child development. Since the concept remains controversial, because most published work is from cross‐sectional studies, we examined the neurodevelopmental trajectories in participants with CL/P through a longitudinal comparison with the general population during early childhood using data from a nationwide birth cohort study in Japan. The linear mixed models for each domain of the Ages and Stages Questionnaire, third edition (ASQ‐3), were used to detect differences in standardised mean scores between groups. The ASQ‐3 is a general neurodevelopmental screening tool comprising communication, gross motor, fine motor, problem‐solving, and personal‐social domains. Participants' neurodevelopment was determined semi‐annually from 6 to 36 months of age. The trajectories of standardised mean scores in each domain showed several significant differences between the control and CL/P groups, with the maximum difference at 24 months of age in the communication domain. Indeed, CL/P was associated with significantly lower scores in the communication (coefficient: –3.31, 95% CI: –5.09 to –1.14), problem‐solving (coefficient: –3.13, 95% CI: –5.07 to –1.18), and personal‐social domains (coefficient: –1.99, 95% CI: –3.87 to –0.11). Trajectories of ASQ‐3 scores suggest neurodevelopmental delays in children with CL/P. [ABSTRACT FROM AUTHOR]

Background: The Quality of Life Adolescent Cleft Questionnaire is a measure of quality of life in cleft lip/palate (CL/P) and includes items on pre‐treatment and post‐treatment status. Items, however, were originally organized in a factor structure that prevents a formal pre‐treatment to post‐treatment comparison. Additionally, the questionnaire was tested in older patients. Aim: We aimed to explore a factor structure that allows a comparison of pre‐ to post‐treatment status in children and adolescents with CL/P. Design: The sample comprised 60 children and adolescents with CL/P. The scale was divided into two groups of items (24 comparing pre‐treatment and post‐treatment status and 26 measuring current quality of life). Two different exploratory and confirmatory analyses were conducted (one for each group of items). Sources of criterion validity were investigated with measures of self‐esteem and self‐efficacy. Results: The results supported a 6‐factor structure for the pre‐treatment and post‐treatment items. In the second group of items, 9 items were removed due to inadequate functioning and a final 4‐factor solution was obtained. The criterion validity of factors was good. Conclusion: The proposed factor solution might be more useful to detect the perceived satisfaction in different areas and can be used in younger patients. [ABSTRACT FROM AUTHOR]

We propose an approach to construct realistic 3D facial morphable models (3DMM) that allows an intuitive facial attribute editing workflow. Current face modeling methods using 3DMM suffer from a lack of local control. We thus create a 3DMM by combining local part‐based 3DMM for the eyes, nose, mouth, ears, and facial mask regions. Our local principal component analysis (PCA)‐based approach uses a novel method to select the best eigenvectors from the local 3DMM to ensure that the combined 3DMM is expressive, while allowing accurate reconstruction. We provide different editing paradigms, all designed from the analysis of the data set. Some use anthropometric measurements from the literature and others allow the user to control the dominant modes of variation extracted from the data set. Our part‐based 3DMM is compact, yet accurate, and compared to other 3DMM methods, it provides a new trade‐off between local and global control. We tested our approach on a data set of 135 scans used to derive the 3DMM, plus 19 scans that served for validation. The results show that our part‐based 3DMM approach has excellent generative properties and allows the user intuitive local control. [ABSTRACT FROM AUTHOR]

Objective(s): To create and validate a synthetic simulator for teaching tracheostomy and laryngotracheal reconstruction (LTR) using anterior costal cartilage and thyroid ala cartilage grafts. Methods: A late adolescent/adult neck and airway simulator was constructed based on CT scans from a cadaver and a live patient. Images were segmented to create three‐dimensional printed molds from which anatomical parts were casted. To evaluate the simulator, expert otolaryngologists ‐ head and neck surgeons performed tracheostomy and LTR using anterior costal cartilage and thyroid ala cartilage grafts on a live anesthetized porcine model (gold standard) followed by the synthetic simulator. They evaluated each model for face validity (realism and anatomical accuracy) and content validity (perceived effectiveness as a training tool) using a five‐point Likert scale. For each expert, differences for each item on each simulator were compared using Wilcoxon Signed‐Rank tests with Sidak correction. Results: Nine expert faculty surgeons completed the study. Experts rated face and content validity of the synthetic simulator an overall median of 4 and 5, respectively. There was no difference in scores between the synthetic model and the live porcine model for any of the steps of any of the surgical procedures. Conclusion: The synthetic simulator created for this study has high face and content validity for tracheostomy and LTR with anterior costal cartilage and thyroid ala cartilage grafts and was not found to be different than the live porcine model for these procedures. Level of Evidence: 5 Laryngoscope, 131:E2378–E2386, 2021 [ABSTRACT FROM AUTHOR]

Aim: This study examined the consensus between the primary care radiological diagnosis and specialist clinical diagnosis of abnormal skull shapes in children.Methods: We performed a retrospective review of children treated at the National Paediatric Craniofacial Centre at Children's Health Ireland, Dublin, Ireland. Group 1 were referred by primary care colleagues concerned about suspected abnormal skull shapes from 1 January 2015 to 30 May 2017. These included cases where they sought specialist confirmation that the skull shape was normal. Group 2 underwent surgery for craniosynostosis from 1 January 2011 to 25 October 2017. The primary care skull X-ray reports were examined for both groups to see whether they matched the specialist diagnosis.Results: Group 1 comprised 300 children, and 59 (20%) had pre-referral skull X-rays. The primary care X-ray reports and specialist diagnoses agreed in 44 (75%) cases, including 19 (43%) who had a normal skull shape. Group 2 comprised 274 children, and 63 (23%) had pre-referral skull X-rays. In this group, there was agreement in 41 (65%) diagnoses; however, the primary care X-ray reports did not diagnose craniosynostosis for the remaining 22 (35%) children.Conclusion: X-rays were of little value in diagnosing abnormal skull shapes, especially craniosynostosis, and primary care clinicians should refer concerns to specialist teams. [ABSTRACT FROM AUTHOR]

Background: Mandibulotomy helps access posterior oral cavity tumors. If osteotomy designs affect postoperative and postradiotherapy complications, needs to be tested clinically. Methods: Two hundred and eighteen patients who underwent midline mandibulotomy for primary tongue cancer wide excision and flap reconstruction at Chang Gung Memorial Hospital during 2014‐2019. Results: There were 114 straight, 54 notched, and 50 stair‐stepped osteotomy cases. Stair‐stepped osteotomy had less advanced tumor stages (P =.009) and notched osteotomy more common single‐plate fixations (P =.012). The former showed higher mandibular heights (P =.000) and more intact midline teeth (P =.011) than notched and straight ones. Straight osteotomy cases showed lower early infection rates (P =.039). Single‐plate fixation was related to more flap dehiscence (P =.001) and oro‐cutaneous fistulas (P =.035). Conclusions: Complex osteotomy does not offer long‐term benefits in midline mandibulotomies for primary tongue cancers and has higher early infections. Single‐plate fixation increases postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Linear scleroderma "en coups de sabre" is a disease that causes scar‐like lesions in the forehead and the scalp, and atrophy of the underlying structures. The result is an acute facial asymmetry that can be distressing to affected young adults. Several surgical treatments are available such as free tissue transfer and synthetic fillers. Aims: In this report, we present a rare case of linear scleroderma "en coups de sabre," which was successfully managed with single‐stage autologous fat grafting. Patients/Methods: The patient was a 17‐year‐old male who presented with a soft‐tissue defect in the left forehead region. Treatment consisted of transferring autologous fat into the defect in a retrograde fashion, as described by Coleman, and overcorrecting the defect to account for fat resorption. Results: At 6 mo postoperatively, the patient had maintained a satisfactory correction of his left forehead and scalp regions with minimal resorption of fat. Conclusion: Autologous fat grafting provides a safe and easy approach for the treatment of linear scleroderma "en coups de sabre". With minimal manipulation of the aspirated fat, combined with overcorrection of the defect, long‐term clinically satisfactory results can be obtained. [ABSTRACT FROM AUTHOR]

Reconstructive surgery transfers viable tissue to cover defects and to restore aesthetic and functional properties. Failure rates after free flap surgery range from 3 to 7%. Co‐morbidities such as diabetes mellitus or peripheral vascular disease increase the risk of flap failure up to 4.5‐fold. Experimental therapeutic concepts commonly use a monocausal approach by applying single growth factors. The secretome of γ‐irradiated, stressed peripheral blood mononuclear cells (PBMCsec) resembles the physiological environment necessary for tissue regeneration. Its application led to improved wound healing rates and a two‐fold increase in blood vessel counts in previous animal models. We hypothesized that PBMCsec has beneficial effects on the survival of compromised flap tissue by reducing the necrosis rate and increasing angiogenesis. Surgery was performed on 39 male Sprague–Dawley rats (control, N = 13; fibrin sealant, N = 14; PBMCsec, N = 12). PBMCsec was produced according to good manufacturing practices (GMP) guidelines and 2 ml were administered intraoperatively at a concentration of 2.5 × 107 cells/ml using fibrin sealant as carrier substance. Flap perfusion and necrosis (as percentage of the total flap area) were analyzed using Laser Doppler Imaging and digital image planimetry on postoperative days 3 and 7. Immunohistochemical stainings for von Willebrand factor (vWF) and Vascular Endothelial Growth Factor‐receptor‐3 (Flt‐4) were performed on postoperative day 7 to evaluate formation of blood vessels and lymphatic vessels. Seroma formation was quantified using a syringe and flap adhesion and tissue edema were evaluated clinically through a cranial incision by a blinded observer according to previously described criteria on postoperative day 7. We found a significantly reduced tissue necrosis rate (control: 27.8% ± 8.6; fibrin: 22.0% ± 6.2; 20.9% reduction, p =.053 vs. control; PBMCsec: 19.1% ± 7.2; 31.1% reduction, p =.012 vs. control; 12.9% reduction, 0.293 vs. fibrin) together with increased vWF+ vessel counts (control: 70.3 ± 16.3 vessels/4 fields at 200× magnification; fibrin: 67.8 ± 12.1; 3.6% reduction, p =.651, vs. control; PBMCsec: 85.9 ± 20.4; 22.2% increase, p =.045 vs. control; 26.7% increase, p =.010 vs. fibrin) on postoperative day 7 after treatment with PBMCsec. Seroma formation was decreased after treatment with fibrin sealant with or without the addition of PBMCsec. (control: 11.9 ± 9.7 ml; fibrin: 1.7 ± 5.3, 86.0% reduction, 0.004 vs. control; PBMCsec: 0.6 ± 2.0; 94.8% reduction, p =.001 vs. control; 62.8% reduction, p =.523 vs. fibrin). We describe the beneficial effects of a secretome derived from γ‐irradiated PBMCs on tissue survival, angiogenesis, and clinical parameters after flap surgery in a rodent epigastric flap model. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To evaluate the validity of a live porcine model for surgical training in tracheostomy and open-airway surgery.Study Design: Prospective observational study.Methods: Eleven expert otolaryngologists-head and neck surgeons rated a live porcine model's realism/anatomical accuracy (face validity) and perceived effectiveness as a training tool (content validity) for tracheostomy and laryngotracheoplasty using anterior costal cartilage and thyroid ala cartilage grafts using a 53-item post-trial questionnaire with a five-point Likert scale.Results: Experts rated the face validity of the live porcine model a median (interquartile range [IQR]) of 4/5 (4-5) and the content validity a median (IQR) of 5/5 (4-5) for each surgical procedure. Overall, 91% strongly agreed or agreed that the simulator would increase trainee competency for tracheostomy and laryngotracheoplasty using costal cartilage graft, and 82% strongly agreed or agreed that it would increase trainee competency for laryngotracheoplasty using thyroid ala cartilage graft.Conclusions: The live porcine model has high face and content validity as a training tool for tracheostomy and laryngotracheoplasty using costal cartilage and thyroid ala cartilage grafts. This training model can help surgical trainees practice these complex, low-frequency procedures.Level Of Evidence: NA Laryngoscope, 130: 2063-2068, 2020. [ABSTRACT FROM AUTHOR]

Most of the previous studies about nose prediction were concentrated only some landmarks of the nose. This study aimed to generate prediction equations for ten landmarks of the nose in the midline and alar regions for forensic facial approximation. The six midline landmarks were the sellion, nasion–pronasale posterior, nasion–pronasale anterior, pronasale, nasal drop, and subnasale. The four landmarks of the alar region were the alare, superior alar groove, posterior alar groove, and inferior alar groove. We used the skull landmarks in the nasal, zygomatic, and maxillary bone to predict the landmarks of the nose. Cone‐beam computed tomography scans of 108 Thai subjects with normal BMI and age ranging from 21.0 to 50.9 years were obtained in a sitting position. The data were converted into three‐dimensional (3‐D) images of the skull and face. The Cartesian coordinates of the landmarks of the skull and nose were used to formulate the multiple regression equations. The formulated equations were tested in 24 new subjects. The mean differences in the predicted midline landmarks varied between −0.4 mm and 0.5 mm, whereas those for bilateral landmarks varied between −1.0 mm and 1.4 mm. In conclusion, the prediction equations formulated here will be beneficial for facial approximation of the nose in a Thai population. [ABSTRACT FROM AUTHOR]

Objective: To investigate causes of failure of free flap reconstructions in patients undergoing reconstruction of head and neck defects.Study Design: Case series with chart review.Setting: Single tertiary care center.Subjects and Methods: Patients underwent reconstruction between January 2007 and June 2017 (n = 892). Variables included were clinical characteristics, social history, defect site, donor tissue, ischemia time, and postoperative complications. Statistical methods used include univariable and multivariable analysis of failure.Results: The overall failure rate was 4.8% (n = 43). Intraoperative ischemia time was associated with free flap failures (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.019-1.107; P = .004) for each addition of 5 minutes. Free flaps that required pedicle revision at time of initial surgery were 9 times more likely to fail (OR, 9.953; 95% CI, 3.242-27.732; P < .001). Patients who experienced alcohol withdrawal after free flap placement were 3.7 times more likely to experience flap failure (OR, 3.690; 95% CI, 1.141-10.330; P = .031). Ischemia time remained an independent significant risk factor for failure in nonosteocutaneous free flaps (OR, 1.105; 95% CI, 1.031-1.185). Alcohol withdrawal was associated with free flap failure in osteocutaneous reconstructions (OR, 5.046; 95% CI 1.103-19.805) while hypertension was found to be protective (OR, 0.056; 95% CI, 0.000-0.445).Conclusion: Prolonged ischemia time, pedicle revision, and alcohol withdrawal were associated with higher rates of flap failure. Employing strategies to minimize ischemic time may have potential to decrease failure rates. Flaps that require pedicle revision and patients with a history of significant alcohol use require closer monitoring. [ABSTRACT FROM AUTHOR]

Background: Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods: Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results: Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions: The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy. [ABSTRACT FROM AUTHOR]

Objectives: To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies.Settings and Sample Population: Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n = 279) and eight-ten (n = 191) years of age.Materials& Methods: Cropped images were assessed using the Asher-McDade (AM) and a 100 mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra- and inter-rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation.Results: The AM intra-rater reliability was moderate/substantial, whilst inter-rater reliability was fair. The VAS intra-rater correlations were high, and inter-rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP.Conclusions: The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability. [ABSTRACT FROM AUTHOR]

Objective: To describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities. Design: Prospective, observational and cross‐sectional study. Setting: Centro Hospitalar do Porto. Participants: A 100 Caucasian Mediterranean patients seeking rhinoplasty. Outcomes: Standardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected. Results: There was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal–hump and nasofrontal–supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%). Conclusion: The present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore the sonographic findings of fetuses with craniosynostosis and investigate their prognosis. We conducted a 5‐year, multicenter retrospective study and collected data on patients with craniosynostosis diagnosed in the perinatal period. Of 41 cases, 30 cases (73%) were syndromic craniosynostosis, eight cases (20%) were non‐syndromic craniosynostosis and the other three cases (7%) were secondary craniosynostosis of chromosomal deletion syndromes. The prenatal ultrasound detection rate was 61%. Half of the cases of syndromic craniosynostosis detected during the perinatal period were Pfeiffer syndrome; there were also six cases of Apert syndrome, three cases of Crouzon syndrome and other rare form of syndromic craniosynostosis (Beare‐Stevenson syndrome, Saethre‐Chotzen syndrome, cranioectodermal dysplasia, and thanatophoric dysplasia). Abnormal shape of the skull was the most common finding leading to prenatal diagnosis of craniosynostosis. Abnormal head biometry, which was the second most frequent finding, was closely correlated with deformation of the cranial shape. Three cases presented with ventriculomegaly and exophthalmos but normal cranial shape and size. The overall survival rate of infants with syndromic craniosynostosis was 79%, while all of the infants with non‐syndromic craniosynostosis survived. In conclusion, prenatal diagnosis of craniosynostosis is difficult, especially when dysmorphic change of the fetal cranium is not evident. Abnormal head biometry and ventriculomegaly could potentially be additional markers of fetal craniosynostosis and consequently increase the prenatal detection rate. [ABSTRACT FROM AUTHOR]

Objectives: To test smile dimension variations in adult African American and Caucasian females and males.Setting and Sample Population: The University of Alabama at Birmingham School of Dentistry and Hospital. Three hundred and ninety-four participants were recruited; African American females and males distributed over five age groups: 20-30, 30-40, 40-50, 50-60 and older than 60.Material& Methods: Three-dimensional surface imaging was used to acquire two images of each participant, one at rest and one upon smile. Landmarks were plotted on the lips and linear distances measured to assess the length of the upper and lower lips, mouth width at rest and upon smile, gingival and dental display upon smile.Results: Linear dimensions are larger in males than in females, and in African Americans than in Caucasians, except for the length of the upper lip that does not differ between male African American and Caucasian males, in any given age group. Gingival display and dental display decrease with age in all groups.Conclusion: Norms should reflect race, age and sex in order to optimize treatment goals. [ABSTRACT FROM AUTHOR]

Restoring adequate blood supply is essential to the success of bone repair and augmentation procedures in craniofacial surgery. Nevertheless, the manner by which the incorporation of collagen gels (which can potentially induce angiogenesis), particulated deproteinized bovine bone grafts, or a combination of both can accelerate or delay bone regeneration in a clinical setting remains controversial. The objective of this study was to evaluate radiographically and histologically the capacity and functionality of particulated bone grafts and collagen gels on bone ossification and soft tissue formation in a rabbit calvarial defect. Bilateral calvarial defects in adult white New Zealand rabbits were filled or left either unfilled with bone grafts (DBBM), collagen gels (Gel), or a combination of both (DBBM + Gel). The defects were allowed to heal for 1, 2, and 6 months postoperatively before termination. Healing and regeneration patterns were assessed by 3D µCT and histological methods, and the biomechanical properties of regenerated tissue constructs were investigated and compared with autogenous calvarial bone. Results show that implanted DBBM and DBBM + Gel significantly enhanced immature bone formation compared with the empty and Gel groups; the latter treatment improved soft tissue formation and impeded immature bone formation but yielded no significant effect on mature bone formation. Implantation of DBBM not only effectively reconstructed 188.83 ± 25.25% of the tissue volume of the original defect, but it also regenerated bone tissue with similar tissue composition and biomechanical properties as the original autogenous bone. We also show that implanting different biomaterials can control the composition of soft and hard tissue in reconstructed tissue constructs in calvarial bone defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 529–544, 2019. [ABSTRACT FROM AUTHOR]

Previous studies have used longitudinal samples to investigate growth of the skeletal aspects of the face, although far less has been done on facial soft tissue. This study uses a larger sample than previous studies on the same data (Denver and Fels growth series) to explore covariation of bony and soft facial dimensions comprehensively from childhood to adulthood. A total of 1036 lateral cephalometric radiographs were digitized from 60 individuals, and distances between facial landmarks were measured using ImageJ. Multivariate analysis of variance (MANOVA) showed all bony facial landmark distances were significantly different (p > 0.05) between age groups; however, only half were significantly different between sexes. Further analysis showed the effect of age (calculated as eta‐squared) explained a greater percentage of total variation (20%) than sex (15%). Overall, soft tissue changes between 0 and 19 years of age were small (<3 mm) and only some were correlated to underlying facial skeleton dimensions. [ABSTRACT FROM AUTHOR]

Repair and regeneration of craniofacial tissues is particularly challenging because they comprise a complex structure of hard and soft tissues involved in intricate functions. This study combined collagen scaffolds and human adipose stem cells (hASCs) for oral mucosal and calvarial bone regeneration by using resveratrol (RSV), which affects the differentiation of mesenchymal stem cells. We have evaluated the effect of collagen scaffold‐containing RSV (collagen/RSV) scaffolds both in vitro and in vivo for their wound healing and bone regeneration potential. Scanning electron microscopy and immunostaining results reveal that hASCs adhere well to and proliferate on both collagen scaffolds and collagen/RSV scaffolds. Oral mucosal lesion experiments demonstrated that the collagen/RSV scaffold is more effective in wound closure and contraction than the collagen scaffold. The micro‐computed tomography (μCT) images of calvarial bone display regenerating bone in defects covered with hASCs on collagen/RSV scaffolds that are more visible than that in defects covered with hASCs on a collagen scaffolds. RSV was more effective at inducing hASC differentiation on the collagen scaffold, suggesting that collagen/RSV scaffolds can provide useful biological cues that stimulate craniofacial tissue formation. [ABSTRACT FROM AUTHOR]

Abstract: We established diagnostic criteria and severity classification of localized scleroderma because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for localized scleroderma, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence‐based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of localized scleroderma. [ABSTRACT FROM AUTHOR]

Objectives: The lack of real-time assessment of vascular perfusion changes remains a major weakness in assessing the efficacy of bone marrow stromal cells (BMSC) therapeutic ischemia reperfusion (I/R) injury. This study provides for the first time the real-time in vivo perfusion monitoring in I/R mice with BMSC therapy.Study Design: Animal model.Methods: Surgically created cutaneous flaps perfused by the inferior epigastric vessels were subjected to 3.5 hours of ischemia/reperfusion. Wound healing and vascular perfusion were assessed by Image-J and laser speckle contrast analysis (LSCA) in three groups (sham, I/R, and I/R + BMSC). BMSC tracking was quantified in an additional two groups (with/without I/R) using intravital fluorescent microscopy. The histopathology of skin flaps was examined by hematoxylin and eosin stain. Infiltrated macrophages were analyzed by confocal immunofluorescent microscopy.Results: Postischemic tissues treated with BMSC demonstrated significantly greater survival than I/R control. On days 3 to 7 postreperfusion, both proximal and distal areas in BMSC-treated flaps demonstrated greater levels of perfusion than untreated I/R flaps (P < 0.05). Intravital fluorescent microscopy revealed that numbers of labeled BMSC were significantly increased in the distal area compared to the proximal area in both with and without ischemic mice. Histological examination showed lower necrosis and infiltrated inflammatory cells in I/R + BMSC-treated mice versus I/R controls.Conclusion: BMSC accumulated in I/R flaps and exerted beneficial effects including: 1) improving vascular perfusion and 2) attenuating inflammatory cell infiltration. LSCA facilitates monitoring of the real-time restitution of perfusion during flap wound healing in experimental animals and could also similarly applied in clinical investigations.Level Of Evidence: NA. Laryngoscope, 128:E198-E205, 2018. [ABSTRACT FROM AUTHOR]

Background: Oral Health‐Related Quality‐of‐Life (OHRQoL) measures have been developed and cross‐culturally validated for use in many populations in recent years. Their use in children with cleft lip and/or palate (CLP), however, is not as well established. Aim: This study aimed to validate two OHRQoL instruments for use with Cambodian children and to describe the OHRQoL of a sample of Cambodian children with CLP, compared with other children in the same cohort. Methods: A convenience sample of 133 children aged 2–8 years and their families was recruited from two NGO health services in urban and rural areas of Cambodia. Children were assigned into clinical groups of cleft, malocclusion, severe caries (PUFA ≥ 1), and dentine caries. OHRQoL was measured using the Parental‐Caregivers Perception Questionnaire (P‐CPQ‐16) and Family Impact Scale (FIS‐8). Results: The validity of the instruments was acceptable with an expected gradient in both scale scores being evident across self‐reported oral health ratings. Children with CLP and their families experienced significantly greater impacts on OHRQoL, and the pattern of these impacts differed among the clinical groups. Conclusions: This study has confirmed the validity of the P‐CPQ‐16 and FIS‐8 for use with young Cambodian children. The results impart advocacy for needed improvements in the care of children with CLP and provide a foundation for future epidemiological research of oral health in Cambodia. [ABSTRACT FROM AUTHOR]

Aim To measure the validity and reliability of the Child Oral Health Impact Profile-Short Form ( COHIP- SF) in Australian children with orofacial cleft ( OFC) and to evaluate the need for a proxy report. Design Children with OFC and their proxy completed a COHIP- SF questionnaire. Items were divided into oral health, functional and socio-emotional subscales, and scores on all subscales were compared between and within groups. Results A total of 222 children (average age 11.3, SD = 3.5, range 8.0-14.0) and 215 proxies completed the COHIP- SF, with similar mean scores of 50.8 (SD = 13.7) and 48.1 (SD = 14.0). Excellent internal consistency reliability (Cronbach's alpha 0.9) and convergent validity was evident ( P < 0.001); however, discriminant validity was weaker. There was strong correlation between child and proxy reports (Pearson's r = 0.7), and intraclass correlation coefficients were high indicating good child/proxy agreement. Older children had poor socio-emotional well-being ( P < 0.004), and children with bilateral cleft lip and palate ( CL/P) and velopharyngeal insufficiency/submucous cleft ( VPI/ SMC) had poor functional well-being. Those with private health insurance reported better oral health-related quality of life ( OHRQoL) ( P < 0.05). Conclusion The COHIP- SF is a valid and reliable measure for measuring OHRQoL in Australian children with OFC. Proxy reports did not add further information regarding a child's OHRQoL. [ABSTRACT FROM AUTHOR]

Background Localized scleroderma is a rare inflammatory skin disorder that affects the skin and sometimes underlying subcutaneous tissue, muscles or bones. The disease has two modes of onset: juvenile- ( JLS) and adult-onset (aLoS). Clinical features have impact on diagnostic and treatment recommendations, but no consensus on the disease management depending on the age at diagnosis was given. Objective To identify these features which differentiate aLoS from JLS. Methods A review of the literature was carried out using the MEDLINE to identify studies assessing demographics, subtype distribution, extracutaneous manifestations, comorbidities, delay at diagnosis and outcome in JLS and aLoS. Non-English articles, reviews, case reports, treatment trials that did not investigate long-term outcomes and studies with the fused data for children and adults were excluded. The analysed papers were published between June 1986 and December 2016. Results Fifty-five studies describing JLS or/and aLoS were included for analysis. Female: male ratio in aLoS was higher than in JLS. Adults presented with plaque and generalized subtype more often than paediatric patients. Linear subtype, musculoskeletal, neurologic and ophthalmologic involvement were more frequent, among children. aLoS was likely to be associated with increased prevalence of lichen sclerosus. There was significant delay in diagnosis in both groups of patients. Recurrences of disease were independent of its onset mode. aLoS patients had more poor quality of life scores than did JLS patients. As only a few studies or no studies assessing specified disease subtypes were identified, this limited the ability to compare the adult and paediatric patients with these subtypes. Conclusion Despite more favourable course of aLoS, a thorough understanding of the broad spectrum of domains related to physical, mental, emotional and social functioning of patients seems to be important to the proper management of disease. LoS heterogeneity makes it important to develop universal classification criteria. [ABSTRACT FROM AUTHOR]

New Findings What is the central question of this study? Acetylcholine released from cholinergic nerves can activate both muscarinic and nicotinic receptors. Although each receptor can independently induce cutaneous vasodilatation and eccrine sweating, it remains to be elucidated whether the two receptors interact in order to mediate these responses., What is the main finding and its importance? We show that although nicotinic receptor activation does not modulate muscarinic cutaneous vasodilatation, it lowers the muscarinic receptor agonist threshold at which onset for eccrine sweating (augmentation of muscarinic eccrine sweating) occurs in young men in normothermic resting conditions. These results provide new insights into the physiological significance of nicotinic receptors in the regulation of cutaneous perfusion and eccrine sweating., Acetylcholine released from cholinergic nerves can activate both muscarinic and nicotinic receptors; each is known independently to induce cutaneous vasodilatation and eccrine sweating in humans. However, it is not known whether the two receptors interact in order to mediate cutaneous vasodilatation and eccrine sweating. In 10 young men (27 ± 6 years old), cutaneous vascular conductance and sweat rate were evaluated at intradermal microdialysis sites that were continuously perfused with either lactated Ringer's solution (control) or three different concentrations of nicotine (0.1, 1 and 10 m m), a nicotinic receptor agonist. Co-administration of methacholine, a muscarinic receptor agonist, was performed at all skin sites in a dose-proportional fashion (0.0125, 0.25, 5, 100 and 2000 m m, each for 25 min). Administration of nicotine alone caused dose-dependent transient increases in cutaneous vascular conductance and sweat rate (all P ≤ 0.05), which thereafter returned to pre-nicotine levels, except that a portion of transient responses remained with continuous administration of 10 m m nicotine (both P ≤ 0.05). Cutaneous vascular conductance was increased by administration of ≥0.25 m m methacholine at the control site, and this response was likewise observed in the presence of co-administration of all doses of nicotine used (all P ≤ 0.05). Sweat rate at the control site was increased by administration of ≥0.25 m m methacholine, but the lowest dose of methacholine (0.0125 m m) was able to increase sweat rate in the presence of 10 m m nicotine ( P ≤ 0.05). We conclude that nicotinic receptor activation lowers the muscarinic receptor agonist threshold for eccrine sweating (augmentation of muscarinic sweating) but does not affect muscarinic cutaneous vasodilatation in young men in normothermic resting conditions. [ABSTRACT FROM AUTHOR]

Blood supply is the most important factor determining the survival of a skin flap. Botulinum toxin-A (Botox-A) is used as pharmacologic agent not only for aesthetic purposes, but also for its vasomotor actions. This study was conducted to establish whether local application of Botox-A increased survival of random pattern skin flaps in rats by changing the expression of neurotransmitters. Forty adult Sprague-Dawley rats with a caudally-based random pattern skin flap were divided into two groups: Botox-A group and saline group. Surviving flap area and cutaneous blood flow in the flap were evaluated on postoperative days 3 and 7. After injection of Botox-A, changes in vessels were analyzed using immunohistochemical staining. Levels of norepinephrine, neuropeptide-Y, nitric oxide, and endothelial nitric oxide synthase were analyzed quantitatively by high performance liquid chromatography, Western blot, and colorimetric assay. The survived area in the Botox-A group was significantly higher than that in the control group on postoperative days 3 and 7. Blood flow in the Botox-A group was significantly high in the proximal and middle areas immediately after the operation. The number of CD31-positive vessels in the Botox-A group was significant greater than that in the control group. Norepinephrine level in the Botox-A group decreased significantly immediately after flap elevation and at postoperative day 3. There were no significant differences in neuropeptide-Y level between the two groups. Nitric oxide level did not change significantly in either group despite the increase in endothelial nitric oxide synthase immediately after flap elevation and at 3 days postoperatively. In conclusion, Botox-A increased vascular blood flow and viable flap area in rats by reducing norepinephrine level. In contrast, neuropeptide-Y, another vasoconstrictor, was not affected by Botox-A. Nitric oxide, a vasodilator, was also not affected by Botox-A, despite the significant increase in endothelial nitric oxide synthase expression in the flaps. [ABSTRACT FROM AUTHOR]