The mechanical stimuli generated by orthodontic forces cause deformation of extracellular matrices and cells, vascular changes, inflammation, and the release of active biological agents generating a complex multifactorial sequence of biological events culminating in bone remodelling enabling orthodontic tooth movement. Orthodontic forces on the teeth generate stresses in periodontal tissues according to a number of variables including the type (continuous, interrupted, or intermittent), magnitude, direction, and frequency of the applied load. Whether the strain is compressive or tensile determines whether bone deposition or bone resorption will occur. The mechanically induced strains mediate structural changes in extracellular matrices and in cells, consequently affecting cellular gene expression and function. In the extracellular matrix, mechanosensing molecules integrated into the structure of various proteins can be activated upon load-induced protein unfolding. These specialized molecules have the capacity to sense and then to convert microenvironmental biomechanical stimuli into intracellular biochemical signals that interact to generate a coordinated tissue response. It is also possible that the applied force may directly cause nuclear deformation with configurational changes in chromatin, thus influencing gene expression. In this review article we summarize the current general concepts of mechanotransduction influencing the remodelling of periodontal tissues thus enabling tooth movement in response to applied orthodontic loads.
Dandy-Walker Syndrome (DWS) is a rare congenital brain anomaly affecting the cerebellum and the fourth ventricle. The chief components of the syndrome include cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis. These abnormalities are typically associated with hydrocephalus. Patients often present in infancy for cerebrospinal fluid shunt procedures. Anaesthetic concerns include those related to other frequently associated congenital abnormalities. Airway management requires particular attention. The limited literature on this subject suggests that these patients require postoperative intensive care admission. This is not always possible in the resource-limited environment. This case report describes the successful anaesthetic management of an infant with Dandy-Walker Syndrome without postoperative intensive care admission.
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