Orthognathic Surgical Outcomes in Patients With and Without Craniofacial Anomalies

Purpose The objective of this study is to examine hospitalization outcomes after orthognathic surgery. This study tests the hypothesis that patients with craniofacial anomalies have higher billed hospital charges, longer lengths of stay, and increased odds of development of infectious complications when compared with patients without craniofacial anomalies. Materials and Methods The Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients who underwent an orthognathic surgical procedure were selected. The primary independent variable of interest was presence of a congenital cleft and/or craniofacial anomaly. The outcome variables were the occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of the presence of craniofacial anomalies on outcomes. Results During the study period, a total of 16,515 patients underwent an orthognathic surgical procedure in the United States. Of these patients, 2,760 had a cleft and/or craniofacial anomaly. An infectious complication occurred in 7.4% of those with a craniofacial anomaly (compared with 0.6% of those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared with$56,189 in those without a craniofacial anomaly). The mean length of stay in the hospital in patients with a craniofacial anomaly was 8.8 days (compared with 1.8 days in those without a craniofacial anomaly). These differences in outcomes between patients with and patients without craniofacial anomalies were significant after we adjusted for patient- and hospital-level confounders. Conclusions Patients with a craniofacial anomaly are at higher risk of development of infectious complications, have higher hospital charges, and stay in the hospital for a longer duration after orthognathic surgery when compared with those without a craniofacial anomaly

Relationship between bridging and dimensions of sella turcica with classification of craniofacial skeleton

Purpose: In orthodontics, it is essential to determine the craniofacial skeleton pattern (class I, II, III) for planning treatment. Sella turcica bridging that is seen on lateral cephalometric radiographs is considered as a normal finding. This study aimed to compare sella turcica bridging and its dimensions in patients with various craniofacial patterns. Material and methods: A total of 105 lateral cephalometric radiographs (53 men and 52 women), aged 14-26 years, were randomly and equally assigned to three groups of class I, II, and III, respectively. The length, diameter, and depth of the sella turcica as well as sella turcica bridging were determined on radiographs. The chi-squared test was used for assessing the relationship between sella turcica bridging and craniofacial skeleton classification. ANOVA was used for assessing the relationship between the dimensions of the sella turcica and craniofacial skeleton classification. The Pearson's correlation coefficient was used for assessing the relationship between age and the dimensions of the sella turcica. Results: The sella turcica had a normal shape in 64.76% of patients, whereas 35.33% of patients had sella turcica bridging. In total, 11.42% of patients belonged to class I, 34.28% to class II, and 66.62% to class III. The diameter of the sella turcica had a significant relationship with age; the diameter of the sella turcica increased with age (p < 0.001). Conclusions: There is a significant relationship between craniofacial skeleton patterns and sella turcica bridging, i.e., the incidence of sella turcica bridging is higher in class III patients. The sella turcica had a greater diameter in older patients

Hybrid gene misregulation in multiple developing tissues within a recent adaptive radiation of Cyprinodon pupfishes.

Genetic incompatibilities constitute the final stages of reproductive isolation and speciation, but little is known about incompatibilities that occur within recent adaptive radiations among closely related diverging populations. Crossing divergent species to form hybrids can break up coadapted variation, resulting in genetic incompatibilities within developmental networks shaping divergent adaptive traits. We crossed two closely related sympatric Cyprinodon pupfish species-a dietary generalist and a specialized molluscivore-and measured expression levels in their F1 hybrids to identify regulatory variation underlying the novel craniofacial morphology found in this recent microendemic adaptive radiation. We extracted mRNA from eight day old whole-larvae tissue and from craniofacial tissues dissected from 17-20 day old larvae to compare gene expression between a total of seven F1 hybrids and 24 individuals from parental species populations. We found 3.9% of genes differentially expressed between generalists and molluscivores in whole-larvae tissues and 0.6% of genes differentially expressed in craniofacial tissue. We found that 2.1% of genes were misregulated in whole-larvae hybrids whereas 19.1% of genes were misregulated in hybrid craniofacial tissues, after correcting for sequencing biases. We also measured allele specific expression across 15,429 heterozygous sites to identify putative compensatory regulatory mechanisms underlying differential expression between generalists and molluscivores. Together, our results highlight the importance of considering misregulation as an early indicator of genetic incompatibilities in the context of rapidly diverging adaptive radiations and suggests that compensatory regulatory divergence drives hybrid gene misregulation in developing tissues that give rise to novel craniofacial traits

Standing on the Shoulders of Giants: The Cleft Palate-Craniofacial Journal (1964-1989)Electronic Archive

Current research and clinical practice in cleft palate and craniofacial disorders “stands on the shoulders of giants” who came before us. To enable thirty years of seminal research articles to become digitally available to a worldwide community of students, scholars, and clinicians, a collaboration was forged in 2004 between University of Pittsburgh’s Digital Research Library (DRL) and ACPA, (with the agreement of Allen Press), to create an electronic archive of the first thirty years of the Cleft Palate Craniofacial Journal . The work was performed pro bono, by all parties

Predictability of hand skill and cognitive abilities from craniofacial width in right- and left-handed men and women: relation of skeletal structure to cerebral function

Recently, a family of homeobox genes involved in brain and craniofacial development was identified. In light of this genetic background, we hypothesized that some functional characteristics of human brain (hand skill, cognition) may be linked to some structural characteristics of human skull (e.g. craniofacial width) in humans. Hand preference was assessed by the Oldfield`s Handedness Questionaire. Hand skill was measured by Peg Moving Task. Face width was measured from the anteroposterior cephalograms (X-ray) using right (R) and left (L) zygomatic points. Intelligence “g” was assessed by Cattell`s Culture Fair Intelligence Test; the perceptual-verbal ability was assessed by “Finding A`s Test”; the spatial ability was assessed by the mental rotation task, in right- and left-handed men and women. The percentages of right-, left-, and mixed-faced subjects were close to those found for paw preference in cats. So, Women tended to be more right-faced (R-L > 0) and less left-faced (R-L < 0) than men who were tended to be more left-faced and less right-faced than women. R-L face width inversely correlated with L-R PMT (peg moving time) in left-handers; there was a direct relation between these variables in right-handers. Cattell-IQ linearly increased with R-L face width in left-handers, negatively correlated in right-handed men and women. Verbal ability inversely related to R – L face width in right- and left-handed men, but directly correlated in right-handed women. Number correct on mental rotation task positively linearly correlated with R-L face width in left-handers and right-handed women. It was concluded that the structural-functional coupling revealed in the present work may have its origins in parallel development of the craniofacial skeleton and brain under the influence of homeobox genes

Methanol and isopropanol embryo dosage response curves for wild-type and ethanol-sensitive zebrafish

It is well established that ethanol has an array of negative effects on developing embryos, from craniofacial abnormalities to cognitive deficits and behavioral disorders. Fetal Alcohol Spectrum Disorders (FASD) describes this phenotypic spectrum caused by embryonic ethanol exposure. However, the effects of other small alcohols, such as methanol and isopropanol, have on development are poorly understood. Multiple factors can contribute to the teratogenicity of small alcohols, including timing, dosage and genetic background. Zebrafish (Danio rerio) has been shown to be a powerful model in the study ethanol teratogenesis and can serve as a model to study methanol and isopropanol teratogenicity. Here we provide evidence of the dose response to methanol and isopropanol in a wild type and an ethanol- sensitive mutant zebrafish line. We determine the lethal concentrations of methanol and isopropanol on wild type and ethanol-sensitive mutants. We also show effective dose that leads to malformations of the craniofacial skeleton, including defects to the lower jaw and palate. Our data suggest that ethanol-sensitivity may predict sensitivity to other small alcohols. Overall, our results begin to characterize the effects of methanol and isopropanol on developing embryos.Molecular Bioscience

The development of the skull of the Egyptian cobra Naja h. haje (Squamata: Serpentes: Elapidae)

Background: The study of craniofacial development is important in understanding the ontogenetic processes behind morphological diversity. A complete morphological description of the embryonic skull development of the Egyptian cobra, Naja h. haje, is lacking and there has been little comparative discussion of skull development either among elapid snakes or between them and other snakes. Methodology/Principal Findings: We present a description of skull development through a full sequence of developmental stages of the Egyptian cobra, and compare it to other snakes. Associated soft tissues of the head are noted where relevant. The first visible ossification centres are in the supratemporal, prearticular and surangular, with slight ossification visible in parts of the maxilla, prefrontal, and dentary. Epiotic centres of ossification are present in the supraoccipital, and the body of the supraoccipital forms from the tectum posterior not the tectum synoticum. The venom glands are visible as distinct bodies as early at stage 5 and enlarge later to extend from the otic capsule to the maxilla level with the anterior margin of the eye. The gland becomes more prominent shortly before hatching, concomitant with the development of the fangs. The tongue shows incipient forking at stage 5, and becomes fully bifid at stage 6. Conclusions/significance: We present the first detailed staging series of cranial development for the Egyptian cobra, Naja h. haje. This is one of the first studies since the classical works of G. de Beer and W. Parker that provides a detailed description of cranial development in an advanced snake species. It allows us to correct errors and misinterpretations in previous accounts which were based on a small sample of specimens of uncertain age. Our results highlight potentially significant variation in supraoccipital formation among squamates and the need for further research in this area

Wnt Signaling in Neural Crest Ontogenesis and Oncogenesis.

Neural crest (NC) cells are a temporary population of multipotent stem cells that generate a diverse array of cell types, including craniofacial bone and cartilage, smooth muscle cells, melanocytes, and peripheral neurons and glia during embryonic development. Defective neural crest development can cause severe and common structural birth defects, such as craniofacial anomalies and congenital heart disease. In the early vertebrate embryos, NC cells emerge from the dorsal edge of the neural tube during neurulation and then migrate extensively throughout the anterior-posterior body axis to generate numerous derivatives. Wnt signaling plays essential roles in embryonic development and cancer. This review summarizes current understanding of Wnt signaling in NC cell induction, delamination, migration, multipotency, and fate determination, as well as in NC-derived cancers

Crouzon’s syndrome with adenotonsillitis: conventional surgery in altered anatomy.

Background/Objectives: Crouzon’s syndrome is characterized by premature closure of the cranial sutures, midface hypoplasia, orbital deformities &amp; other associated abnormalities.Children with Crouzon syndrome frequently have obstructive sleep apnea due to the underdevelopment of the midface.Case report: A 12 year old boy of Crouzon’s syndrome with chronic adeno-tonsillitis was managed by adeno-tonsillectomy under general anaesthesia by scalpel cautery method. The boyresponded well to surgery &amp; the mild sleep disorder disappeared within a week uveventfully.Conclusion: Sleep disorders in this condition can be treated by improving the airway by selective procedures like midface advancement, mandibular expansion , adeno-tonsillectomy,uvulo-palatopharyngoplasty, anterior tongue reduction &amp; endoscopic tracheal granuloma excision.