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Maxillomandibular repositioning in orthognathic surgeries has both morphologic and functional effects. These surgeries are thought to change the pharyngeal space and cause obstructive sleep apnea syndrome, however. The primary purpose of this study is to evaluate the effects of jaw movement in bimaxillary orthognathic surgery on airway function and to identify the morphometric factors that can predict postoperative airway function.The subjects were 11 males and 12 females who had undergone orthognathic surgeries of the maxilla and mandible. The results of cephalometric analysis, cross-sectional area of the pharynx (CSA), pharyngeal volume, and computational fluid dynamics (CFD) were compared.The CSA of the nasal (CSA1), total volume, and total nasal volume decreased after surgery with statistical significance. Velocity at the oropharyngeal space (V2) increased after surgery with statistical significance. V2, CSA of the oropharyngeal space (CSA2), and PV were correlated with the horizontal posterior movement of point B, point Menton, and overjet. V2 and CSA2 were correlated with SNB before and after surgery in all 46 analyses. Changes in pharyngeal airflow were more affected by pressure drop in the pharyngeal space (ΔPp) than by pressure drop in the nasal space (ΔPn).The relationship between the actual amount of change in the cephalometric reference point and the airway function is evident. CFD may thus be very useful as morphological analysis in preoperative treatment decision making.

Objective Presurgical infant orthopedics (PIO) reduces the severity of the original cleft and burden on patients and their parents, provides better esthetics and function, and enables surgeons to achieve better surgical repair. To reduce the alveolar cleft width and to predict treatment difficulty using PIO, various measures were examined in pretreatment cast models. Design Retrospective case-control pilot study. Patients The patients were 22 infants with non-syndromic unilateral cleft lip and palate (UCLP), and cast models of these infants were used. Methods After PIO using passive plates, infants with UCLP were divided into two groups: contact group (12 cases with close proximity of the greater and lesser segments) and non-contact group (10 cases without proximity of segments). The two groups were compared, and variables related to the proximity between alveolar clefts were examined. Results There was no significant difference in age at PIO initiation between the two groups. However, the treatment duration was significantly longer in the non-contact group than in the contact group. Among the 13 variables, the initial lateral deviation of the nasal septum was significantly larger in the contact group than in the non-contact group. A significant positive correlation was observed between the initial lateral deviation of the nasal septum and reduction of the alveolar cleft width by PIO. Conclusion Initial lateral deviation of the nasal septum is a predictive factor for the proximity between alveolar segments in infants with UCLP at the PIO.

Cleft lip and palate is a congenital disorder including cleft lip, and/or cleft palate, and/or alveolar cleft, with high incidence.The alveolar cleft causes morphological and functional abnormalities. To obtain bone bridge formation and continuous structure between alveolar clefts, surgical interventions are performed from infancy to childhood. However, desirable bone bridge formation is not obtained in many cases. Regenerative medicine using mesenchymal stem cells (MSCs) is expected to be a useful strategy to obtain sufficient bone bridge formation between alveolar clefts. In this study, we examined the effect of human umbilical cord-derived MSCs by transplantation into a rat experimental alveolar cleft model. Human umbilical cords were digested enzymatically and the isolated cells were collected (UC-EZ cells). Next, CD146-positive cells were enriched from UC-EZ cells by magnetic-activated cell sorting (UC-MACS cells). UC-EZ and UC-MACS cells showed MSC gene/protein expression, in vitro. Both cells had multipotency and could differentiate to osteogenic, chondrogenic, and adipogenic lineages under the differentiation-inducing media. However, UC-EZ cells lacked Sox2 expression and showed the lower ratio of MSCs than UC-MACS cells. Thus, UC-MACS cells were transplanted with hydroxyapatite and collagen (HA + Col) into alveolar cleft model to evaluate bone formation in vivo. The results of micro computed tomography and histological staining showed that UC-MACS cells with HA + Col induced more abundant bone formation between the experimental alveolar clefts than HA + Col implantation only. Cells immunopositive for osteopontin were accumulated along the bone surface and some of them were embedded in the bone. Cells immunopositive for human-specific mitochondria were aligned along the newly formed bone surface and in the new bone, suggesting that UC-MACS cells contributed to the bone bridge formation between alveolar clefts. These findings indicate that human umbilical cords are reliable bioresource and UC-MACS cells are useful for the alveolar cleft regeneration.

Purpose A nationwide collaborative survey was performed in Japan to evaluate the recent treatment outcomes on occlusion after orthodontic/orthognathic treatment for patients with unilateral cleft lip and palate (UCLP). Methods A retrospective collaborative survey was performed. Twenty-five facilities, including 14 university hospitals, examined their orthodontic records and cast models of patients with UCLP. Using common format, information of 492 non-syndromic UCLP cases were reported. Patients with syndromic UCLP or congenital missing maxillary central incisors were excluded. Basically, each facility reported their most recent 30 cases. Results Of 492 cases, 330 cases (67.1%) were reported from 11 facilities, suggesting that orthodontic treatment for patients with CL/P was not fully centralized in Japan. Secondary alveolar bone grafting and orthognathic surgery were performed in 92.7% and 22.5% of cases, respectively. A significantly higher rate of orthognathic surgery was seen in cases reported from university hospitals (27.5%) than other facilities (14.8%). Average age at the end of active orthodontic/orthognathic treatment was 18.5 years. The lateral incisors on cleft sides were congenitally missing in 50.2% and displayed microdontia in 42.9% of cases. After orthodontic treatment, the central incisors and the canines were aligned without interdental spaces in 55.3% of cases. The positive anterior overjet was seen in 88.2%, and the centerline discrepancies between maxillary and mandibular incisors within 1/4 of mandibular incisor width was in 74.8% of cases. Conclusions The final occlusion after orthodontic treatment was satisfactory in most cases. Findings of this study are referable for improving standard Japanese orthodontic care for patients with CL/P.

The aim of this study was to evaluate the craniofacial morphology and pharyngeal airway space in children with both unilateral cleft lip and palate (UCLP) and habitual snoring. Eighteen patients with UCLP visited the Orthodontic Clinic, Meikai University hospital between April 2002 and January 2005. The patients with UCLP were divided into two groups. One group included eight children who were associated with both UCLP and habitual snoring and the other group included 10 children who were associated with both UCLP and non-snoring. In addition, another two groups were obstructive sleep apnea (OSA) and control groups. In the findings, SNA, SNB, ANB, CONVEXITY, A-B PLANE, MANDIBULAR PLANE, ANS-ME, Y-AXIS, D-AD1, D-AD2, D-PTV, and UPPER PHARYNX were selected for comparison with the Mann–Whitney U-test between the two UCLP groups, as a result of the Kruskal–Wallis test. Children with both UCLP and snoring compared to children with UCLP and non-snoring had a large lower anterior facial height and a narrowed pharyngeal airway space. However, children both with UCLP and snoring did not have a skeletal class III with undergrowth in the maxilla. In conclusion, these findings suggested that children with both UCLP and snoring had an OSA risk factor.

The purpose of this study was to examine the reproducibility of portable polysomnography for the evaluation of nocturnal sleep breathing in children with habitual snoring. Seven children and nine adults with habitual snoring were monitored at home during nocturnal sleep for three nights by parents or a bed-partner who had been informed about the use of portable polysomnography. Differences in adult polysomnographic values over the three nights were assessed by two-way ANOVA and Friedman test. The difference in polysomonographic values in children between two nights was assessed with an F-test and a Wilcoxon signed-ranks test. We found no differences in polysomnographic values among the three nights in adults. However, there were differences in Factor A (i.e. Mean SpO2, Lowest SpO2, Mean Apnea Duration and Mean Pulse Rate) among the adult subjects. In children, there was no difference in polysomnographic values between the two nights; however, there were differences in the variance of Mean SpO2 and Mean Apnea Duration between the two nights. In conclusion, to permit children to sleep as naturally as possible, sleep-screening tests can be performed reproducibly at home using portable polysomnography over a few days.

An IF5 cDNA was isolated by expression cloning from a mouse oocyte cDNA library. It encoded a protein of 250 amino acids, and the region of it encoding amino acids 1?137 showed 86.8% alignment with the anti-proliferative domain of BTG/TOB family genes. This gene is also termed BTG4 or PC3B. Transiently expressed IF5/BTG4 induced alkaline phosphatase activity in human embryonic kidney (HEK293T) and 2T3 cells. IF5/BTG4 mRNA was detected by reverse transcription polymerase chain reaction in pharynx, larynx, trachea, oviduct, ovary, caput epididymis, and testis, but not in lung, intestine, or liver. Immunohistochemistry showed the IF5/BTG4 protein to be present in epithelial cells of the tongue, palate, pharynx, internal nose, and trachea. Both protein and mRNA levels of IF5/BTG4 were reduced by aging when comparing 4-week-old mice with 48-week-old mice. Our findings suggest that IF5/BTG4 may be an aging-related gene in epithelial cells. IF5/BTG4 was shown to be an aging-related gene, whose expression decreases with aging in the oral and respiratory cavities. Furthermore, IF5/BTG4 regulates cell differentiation., Original Article: The online platform for Taylor & Francis Online.

Diethylenetriaminepenta-acetic acid (DTPA) inhibits human cytomegalovirus (CMV) replication in vitro, although the mechanism has remained unclear. The present study shows that DTPA inhibits CMV major immediate-early (MIE) promoter activity in a luciferase reporter assay, whereas its enhancer-less promoter was not affected. The inhibitory effect of DTPA on CMV MIE promoter activity was abrogated by stoichiometric amounts of cations in the following (decreasing) order, Zn(2+)>Co(2+)>Ni(2+)>Cu(2+)>Fe(3+)>Fe(2+), but not by Mn(2+). These cations bind to DTPA and may limit the zinc-chelating capability. In the absence of DTPA, exogenous zinc activated CMV MIE promoter activity in a dose-dependent manner, but not its enhancer-less promoter. The intracellular metallothionein content of DTPA- and cation-treated cultures was significantly correlated with CMV MIE promoter activity. DTPA may inhibit CMV replication by regulating CMV MIE promoter activity through controlling the availability of cellular zinc. Since the CMV MIE promoter has no consensus sequence for a metal responsive element, a novel mechanism for metal-regulated transcription may be involved in this process.

It is known that various factors are related to the habitual snoring, such as mouth breathing, obesity, deviation of nasal septum, and respiratory muscle. Patients with cleft lip and palate are acc...

Our previous studies reported that habitual snoring children with unilateral cleft lip and palate (UCLP) had a large anterior facial height and narrow airway, but the sagittal position of maxilla a...

By means of lateral cephalograms, various items related to the maxillofacial and airway morphologies were first assessed in four groups (referred to as unilateral cleft lip and palate; [UCLP] + sno...