Objective-Children with a cleft of the upper lip exhibit obvious facial disfigurement. Many require multiple lip surgeries for an optimal esthetic result. However, because the decision for lip revision is based on subjective clinical criteria, clinicians may disagree on whether these surgeries should be performed. To establish more reliable, functionally relevant outcome criteria for evaluation and treatment planning, a clinical trial currently is in progress. In this article, the design of the clinical trial is described and results of a study on subjective evaluations of facial form by surgeons for or against the need for lip revision surgery are presented.Design-Parallel, three-group, nonrandomized clinical trial and subjective evaluations/ratings of facial views by surgeons.Subjects-For the clinical trial, children with repaired cleft lip and palate scheduled for a secondary lip revision, children with repaired cleft lip and palate who did not have lip revision, and noncleft children. For the subjective evaluations, surgeons' facial ratings of 21 children with repaired cleft lip.Address correspondence to: Dr. Carroll-Ann Trotman, CB #7450, 275 Brauer Hall, Chapel Hill, NC 27599-7450. carrollann_trotman@dentistry.unc.edu.. NIH Public Access Author ManuscriptCleft Palate Craniofac J. Author manuscript; available in PMC 2013 May 07. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAnalysis-Descriptive and Kappa statistics assessing the concordance of surgeons' ratings of (a) repeated facial views and (b) a recommendation of revision on viewing the prerevision and postrevision views.Results-The surgeons' consistency in rating repeated views was moderate to excellent; however, agreement among the surgeons when rating individual participants was low to moderate.Conclusions-The findings suggest that the agreement among surgeons was poor and support the need for more objective measures to assess the need for revision surgery. Keywords clinical trial; functional outcomes; lip revision surgeryFor a child with a cleft of the lip with or without a cleft palate, the decision to surgically revise the lip is based on a subjective evaluation of lip form and function that is made by the surgeon either independently or in conjunction with the patient and parents (Marsh, 1990). Subjective evaluation defines the current standard of care for patients who are candidates for lip revision; however, recent research has demonstrated many limitations with the use of subjective assessments. Of particular concern are the lack of agreement among clinicians (Asher-McDade et al., 1991;Tobiason et al., 1991;Ritter et al., 2002;Morrant and Shaw, 1996) and a tendency for the assessment of lip form to confound the assessment of lip function (Ritter et al., 2002). For example, when the severity of the deformity of static faces (i.e., faces at rest) was rated subjectively by clinicians, interexaminer agreement ranged from low (Asher-McDade et al., 1991) to good (Tobiason et al., 1991;Ritter et al., 2002), whi...
Purpose-The purpose of this study was to determine the facial movement characteristics of patients who underwent orthognathic surgery. The specific aims were to determine the presurgery versus postsurgery differences in facial movements; to determine whether the presurgery facial movements were similar among patients with different dentofacial deformities; and to determine whether patients have a more similar post-than presurgery dentofacial morphology and soft tissue movement. The hypothesis was that there are differences between the pre-and postsurgery facial movements.Patients and Methods-The sample consisted of 19 patients (11 women, 8 men) with a mean age of 20.6 years (SD ± 8.34). Facial movement and lateral cephalometric data were collected at presurgery, and at 6 and 12 months postsurgery. Measures of the facial skeletal differences were made from lateral cephalometric radiographs and facial movements were recorded by a videobased tracking system. Descriptive and inferential statistics were performed on principal component scores generated from the movement data. A linear mixed-effects model was used to test for significant differences in movement.Results-Differences were found between the presurgery and 12-month postsurgery visits for the instructed smile, lip purse, eye closure, grimace, and mouth opening movements as well as the natural smile. Also, there were significant differences at presurgery among the dentofacial groups for the lip purse movement but no differences were found at postsurgery for any of the movements.Conclusion-These findings suggest that facial movements are effected by skeletal malocclusion and orthognathic surgical procedures.Facial appearance and our expressive behaviors have a major impact on how we are perceived and how others in society perceive us. For an individual with a facial functional impairment and/or disfigurement, however, these interactions and associated perceptions Early methods to evaluate facial impairments were based on 2-dimensional (2D) measures; however, because of a lack of information in all planes of space and a resultant oversimplification of the findings, 3-dimensional (3D) measures are now preferred. 1 Currently, 3D measures generated from video-based tracking techniques are regarded as the most valid approach to record and evaluate facial movements. [2][3][4][5][6][7][8][9][10] For the correction of facial disfigurements caused by dentofacial deformities, the standard procedure is orthognathic surgery. This type of surgery is reasonably predictable and results in a harmonization of facial skeletal structures. 11-13 Much less is known, however, about the pre-and postsurgery facial soft tissue function in orthognathic surgery patients, and whether impairments in movement exist in association with the skeletal deformity. Previous research has suggested that patients with severe skeletal deformities have impairments in movement outside the range of that seen in unaffected individuals. 9 If functional impairments exist presurgically in orthognat...
Our results argue that tracking instrumentation is a potentially useful tool in the measurement of facial mobility.
The objective measurement of movement may be used as an outcome measure for cleft lip surgery.
There has been little research on the seeding of human umbilical cord mesenchymal stem cells (hUCMSCs) in three-dimensional scaffolds for muscle tissue engineering. The objectives of this study were: (i) to seed hUCMSCs in a fibrin hydrogel containing fast-degradable microbeads (dMBs) to create macropores to enhance cell viability; and (ii) to investigate the encapsulated cell proliferation and myogenic differentiation for muscle tissue engineering. Mass fractions of 0–80% of dMBs were tested, and 35% of dMBs in fibrin was shown to avoid fibrin shrinkage while creating macropores and promoting cell viability. This construct was referred to as “dMB35”. Fibrin without dMBs was termed “dMB0”. Microbead degradation created macropores in fibrin and improved cell viability. The percentage of live cells in dMB35 reached 91% at 16 days, higher than the 81% in dMB0 (p < 0.05). Live cell density in dMB35 was 1.6-fold that of dMB0 (p < 0.05). The encapsulated hUCMSCs proliferated, increasing the cell density by 2.6 times in dMB35 from 1 to 16 days. MTT activity for dMB35 was substantially higher than that for dMB0 at 16 days (p < 0.05). hUCMSCs in dMB35 had high gene expressions of myotube markers of myosin heavy chain 1 (MYH1) and alpha-actinin 3 (ACTN3). Elongated, multinucleated cells were formed with positive staining of myogenic specific proteins including myogenin, MYH, ACTN and actin alpha 1. Moreover, a significant increase in cell fusion was detected with myogenic induction. In conclusion, hUCMSCs were encapsulated in fibrin with degradable microbeads for the first time, achieving greatly enhanced cell viability and successful myogenic differentiation with formation of multinucleated myotubes. The injectable and macroporous fibrin–dMB–hUCMSC construct may be promising for muscle tissue engineering applications.
Cleft lip with or without cleft palate is the most common congenital malformation of the head and the third-most common birth defect. Surgical repair of the lip is the only treatment and is usually performed during the first year of life. Hypertrophic scar (HTS) formation is a frequent postoperative complication that impairs soft tissue form, function, or movement. Multiple lip revision operations are often required throughout childhood, attempting to optimize aesthetics and function. The mechanisms guiding HTS formation are multifactorial and complex. HTS is the result of dysregulated wound healing, where excessive collagen and extracellular matrix proteins are deposited within the wound area, resulting in persistent inflammation and resultant fibrosis. Many studies support the contribution of dysregulated, exaggerated inflammation in scar formation. Fibrosis and scarring result from chronic inflammation that interrupts tissue remodeling in normal wound healing. Failure of active resolution of inflammation pathways has been implicated. The management of HTS has been challenging for clinicians, since current therapies are minimally effective. Emerging evidence that specialized proresolving mediators of inflammation accelerate wound healing by preventing chronic inflammation and allowing natural uninterrupted tissue remodeling suggests new therapeutic opportunities in the prevention and management of HTS.
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