Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate.

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; range, 0.5 to 4 mm). In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased S-N-ANS angle with increased alveolar cleft width.     

Children with repaired bilateral cleft lip/palate: effect of age at premaxillary osteotomy on facial growth.

This study compared facial growth in three groups of patients with bilateral complete cleft lip/palate: those who had (1) no premaxillary osteotomy, (2) premaxillary osteotomy before age 8 years, and (3) premaxillary osteotomy after age 8 years. Of 24 children with bilateral complete cleft lip/palate, 7 had early premaxillary osteotomy (mean age, 6.1; range, 3.7 to 7.6 years), 10 had late osteotomy (mean age, 11.2; range, 8.3 to 20.7 years), and 7 did not require premaxillary repositioning and served as controls (mean age, 12.4; range, 6.4 to 17.8 years). Presurgical and postsurgical lateral cephalograms were digitized using the Dentofacial Planner software; most current lateral cephalograms comprised the control group. Forty-one bony and 25 soft-tissue landmarks were digitized, and 8 angles were measured: SNA, (sella-nasion-A point), SNPg (sella-nasion-pogonion), ANB (A point-nasion-B point), NAPg (nasion-A point-pogonion), ST convexity (glabella-subnasale-soft-tissue pogonion), Sn-G vertical (line perpendicular to the horizontal plane dropped from glabella and distance measured from subnasale to this vertical), Cm-Sn-Ls (columella-subnasale-abial superioris), and Sn-Gn-C (subnasale-soft-tissue gnathion-chin point). Statistical difference in mean preoperative and postoperative values were measured with analysis of variance. Tests of significance were adjusted for multiple comparisons using the Bonferroni correction. Mean age at follow-up for early, late, and control groups was 11.8, 14.0, and 12.4 years, respectively. Mean follow-up for early and late groups was 5.7 and 2.8 years. There was a significant preoperative difference among the three groups for mean SNA (p < 0.01), ANB (p < 0.01), and NAPg (p < 0.01). Bonferroni analyses revealed that the early group had significantly greater SNA, ANB, and NAPg angles than the late (p < 0.01) and control groups (p < 0.05). There was a significant postoperative difference among groups for ANB (p < 0.05); Bonferroni analyses also showed that the control group had a significantly greater ANB than the late group (p < 0.05). The t test for equity of means established postoperative change for SNA (p < 0.01), ANB (p< 0.01), NAPg (p < 0.01), and ST convexity (p < 0.01) for the early group was significantly greater than for the late group. Children who required early premaxillary positioning had more significant preoperative deformity; however, this group's postoperative profile was not, on average, significantly different from either the late or control groups. Our findings that the early group had more significant change with premaxillary osteotomy than the late group suggest that premaxillary positioning can be done before completion of facial growth without compromise.     

Lip-nasal aesthetics following Le Fort I osteotomy

Forty-one patients undergoing Le Fort I osteotomy for superior and/or anterior repositioning of the maxilla were prospectively studied for changes in soft-tissue morphology of the nasomaxillary region. Nasal parameters studied were changes in interalar rim width and nasal tip projection. It was observed that alar rim width increases with anterior and/or superior repositioning of the maxilla, but increases in nasal tip projection occur only when there is an anterior vector of maxillary movement. These nasal changes could not be quantitatively correlated to magnitude of maxillary movement. Lip changes studied were the horizontal displacement at the vermilion border and subnasale versus that of the incisal edge and point A, respectively, when the maxilla is sagittally advanced and the vertical shortening of the lip versus that of the incisal edge when the maxilla is shortened. Using linear regression analysis, horizontal displacement of the upper lip at the vermilion border was 0.82 +/- 0.13 mm for every 1 mm of maxillary advancement at the incisal edge (p less than 0.001) and 0.51 +/- 0.13 at the subnasale for every 1 mm of maxillary advancement at point A (p less than 0.001). Eighty percent of patients undergoing maxillary intrusive procedures had lip shortening ranging from 20 to 50 percent of the vertical maxillary reduction. Surprisingly, no statistically significant correlation could be demonstrated for lip shortening versus extent of vertical maxillary reduction. Previous literature in disagreement with these findings is discussed. Guidelines for treatment planning utilizing these data are suggested.     

Cephalometric analysis of the craniofacial region of the northern Foxe Basin Eskimo

Past investigations of the Eskimo have indicated that there are marked morphological differences in the craniofacial skeleton of this relatively isolated ethnic group compared to other ethnic and racial groups. This study, using cephalometric radiography, attempted to characterize the craniofacial phenotype of the Eskimo living in the northern Foxe Basin, Northwest Territories, Canada. Age changes were examined on a cross-sectional basis with comparisons being made with a Winnipeg Caucasian group. This investigation indicates that the Igloolik Eskimo has a phenotype, established early in life, and is distinct from the Winnipeg group. The overall size of the Eskimo craniofacial complex was significantly larger at three years of age and remained larger through the ages studied. Development of the craniofacial region, however, was fairly similar in rate and direction for both populations. The greatest differences between the Eskimo and Caucasian groups were found in the linear measurements assessing cranial width, facial width, mandibular length, facial height, protrusion of the incisors, chin point development, and nasal morphology. Differences between the two groups in the morphological relationships of the component structures include the angular relationships of the maxilla and nasal bones to the anterior cranial base, the gonial angle of the mandible, and the angle of facial convexity.     

The aesthetic earlobe: classification of lobule ptosis on the basis of a survey of North American Caucasians

North American Caucasian male subjects (n = 59) and female subjects (n = 72) were surveyed, to investigate earlobe height preferences that could serve as guidelines for aesthetic earlobe surgical procedures and reconstructions. Subjects were asked to rank their preferences for variously shaped earlobes in life-size-scaled sketched male and female profiles. Earlobe heights were varied on the basis of previously established anatomical landmarks, including the intertragal notch, the most caudal anterior attachment of the earlobe to the cheek skin (the otobasion inferius), and the most caudal extension of the earlobe-free margin (the subaurale). While the intertragal notch-to-otobasion inferius distance (range, 5 to 20 mm) and otobasion inferius-to-subaurale distance (range, 0 to 20 mm) varied, all other facial and ear anthropometric measurements were held constant. Each of the rank orders for the female and male facial profiles completed by the female and male subjects demonstrated statistical significance, as determined by one-way analysis of variance analysis of ranks (p < 0.001 for all four groups). No difference was noted between the two sexes' rank orders for either sex (p > 0.05). Therefore, analysis of the combined male and female preferences for each sex was completed with one-way analysis of variance analysis of ranks (p < 0.001 and p < 0.001) and a post hoc Dunn's test, to delineate significant preference differences between subgroups with respect to the intertragal notch-to-otobasion inferius and otobasion inferius-to-subaurale distances. Both female and male earlobe intertragal notch-to-otobasion inferius distances were preferred at either 5, 10, or 15 mm, more so than at 20 mm (p < 0.05 for all female and male comparisons). Furthermore, both female and male earlobe otobasion inferius-to-subaurale distances were preferred, in descending order, at 5 mm > 10 mm > 0 mm > 15 mm > 20 mm (p < 0.05 for all female and male comparisons). On the basis of the findings of this survey, the first classification of earlobe ptosis (based on otobasion inferius-to-subaurale distances), as well as a criterion for earlobe pseudoptosis (intertragal notch-to-otobasion inferius distance of greater than 15 mm), is presented. These findings suggest a role for independent assessment of the lobule length with respect to its anteriorly attached cephalad component (intertragal notch-to-otobasion inferius distance) and its free-margin caudal component (otobasion inferius-to-subaurale distance).     

Ethnic differences in the prevalence of inherited thrombophilic polymorphisms in an asymptomatic Australian prenatal population

Differences in the prevalence of thrombophilias in different ethnic populations have been demonstrated. Because the Australian population includes many different ethnic groups, we sought to assess the effect of ethnicity in our Australian prenatal population on the prevalence of thrombophilic polymorphisms. Asymptomatic, nulliparous women (n = 1,129) recruited for a large prospective study were included in this analysis. These women had no personal or family history of venous thromboembolism and were not known to be carrying an inherited or acquired thrombophilia. Ethnicity was determined at recruitment, and women were categorized as being of Northern European, Southern European, Middle Eastern, Asian, or Other ethnicity. These women underwent genotyping for the following polymorphisms: factor V Leiden G1691A, prothrombin gene A20210G mutation, methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, and thrombomodulin C1418T. The factor V Leiden allele was seen significantly more frequently in patients of Middle Eastern background compared to those of Northern European and Asian ethnicity (p < 0.05). The prothrombin gene mutation was seen significantly more frequently in patients of Southern European ethnicity compared to those of Northern European or Asian ethnicity (p < 0.05). The MTHFR C677T allele (mutant) was significantly less common in those of Asian ethnicity compared to patients of Northern European and Southern European ethnicity (p < 0.0005). There were no significant differences seen with the MTHFR A1298C polymorphism. The mutant thrombomodulin allele was seen significantly more frequently in Asian women compared to Northern European, Southern European, or Middle Eastern women (p < 0.005). There are important ethnic differences in the prevalence of thrombophilic polymorphisms in the Australian prenatal population.     

Incidence of earlobe ptosis and pseudoptosis in patients seeking facial rejuvenation surgery and effects of aging

The authors have previously described a classification system for earlobe ptosis and have established a criterion for earlobe pseudoptosis. Earlobe heights were characterized based on anatomic landmarks, including the intertragal notch, the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek skin), and the subaurale (the most caudal extension of the earlobe free margin). The classification system was derived from earlobe height preferences as determined by a survey of North American Caucasians, and it identified the ideal free caudal lobule height range to measure 1 to 5 mm from otobasion inferius to subaurale (grade I ptosis). Also, earlobe pseudoptosis was defined by the attached cephalic lobule height measuring an intertragal notch to otobasion inferius distance greater than 15 mm. In this study, the preoperative earlobe height measurements of 44 patients seeking facial rejuvenation were evaluated. The average attached cephalic segment (intertragal notch to otobasion inferius distance) of patient earlobes measured 11.10 +/- 0.46 mm, and the average free caudal segment (otobasion inferius to subaurale distance) of patient earlobes measured 7.15 +/- 0.49 mm. Assessment of patient groups based on single-decade age differences demonstrated an increase in the free caudal segment (otobasion inferius to subaurale distance) with increasing age (p = 0.003). Assessment of patient groups based on single-decade age differences demonstrated no increase in the attached cephalic segment (intertragal notch to otobasion inferius distances) with increasing age (p = 0.281). When evaluating for the ideal otobasion inferius to subaurale distance, only 22.2 percent of earlobes demonstrated an ideal free caudal earlobe height (grade I ptosis). Moreover, pseudoptosis was detected in 12.3 percent of earlobes. Finally, a majority of earlobes demonstrated intrapatient variability, with only 16.2 percent of patients demonstrating identical attached cephalic segment (intertragal notch to otobasion inferius distances) and 37.8 percent demonstrating identical free caudal segment (otobasion inferius to subaurale distances) when compared with their contralateral ear. Plastic surgeons should be aware that a significant number of patients (77.8 percent of earlobes) may not possess an ideal free caudal segment and that 12.3 percent of earlobes may present with pseudoptosis. Therefore, earlobe height assessment should be an essential aspect of evaluation in patients desiring facial rejuvenation surgery. Evaluation of both ears should be performed independently due to intrapatient earlobe height variations. Finally, patients should be counseled with regard to the ideal earlobe parameters and aging patterns (stable attached cephalic segment versus increasing free caudal segment). With the natural progression of both facial rhytides and caudal segment earlobe ptosis (increasing free lobule segment) with increasing age, independent and accurate assessment of earlobe height is indicated so that the aging ear may be addressed concurrently with the aging face.     

Structural analysis of human hair single fibres by scanning microbeam SAXS

The origin of the curliness of human hair was revealed by scanning microbeam small angle X-ray scattering (SAXS), based on the nanostructure of keratin fibre arrangement. Scanning microbeam SAXS patterns of single hair fibres have been measured across the fibres and the differences in the patterns between the inner and the outer sides of the curvature were successfully detected. The analysis of the equatorial and azimuthal scattering intensity profiles showed that the arrangement of the intermediate filaments was different between the inner and the outer sides of the curvature. From the analogy with Merino and Romny wool, it is suggested that different types of cortices exist in human hair. It is concluded that, regardless of the ethnic origins (African, Caucasian, and Asian), the macroscopic curl shape of the hair fibre originate from the inhomogeneity of the internal nanostructure, arising from inhomogeneous distribution of two types of cortices.     

闽南人的体质特征

在福建漳州地区调查了322例男性(城市男性为149例,乡村汉族男性为173例)和357例女性(城市女性为164例,乡村女性为193例)成人的86项体质指标,计算了24项体质指数,统计了指数分型情况,与我国族群资料进行了比较,对闽南人体质特征进行了初步分析。结果 1)闽南人有皱褶率高,有蒙古褶率低,眼裂高度眼裂多为狭窄型,眼外角多高于眼内角,鼻根高度多为中等型,直鼻背,颧部突出度多为微弱型;鼻基部男性多呈水平,女性多呈上翘;鼻翼高度多为中等,鼻孔最大径多为斜位,鼻翼较宽;男性耳垂多为圆形,女性多为三角形;上唇皮肤部高度多为中等,红唇男性薄型率、中等型均较高,女性薄型率最高,发黑,肤黄、眼褐。2)总体说来,闽南人头面部测量指标值介于北亚、南亚类型族群之间。3)从指数均数来看,闽南人男女性均为圆头型、高头型、狭面型,狭鼻型。城市女性为狭头型,城市男性、乡村男性、乡村女性为中头型。闽南人头面部指数值更接近于南亚类型族群。4)从体部指标值和体部指数来看。闽南人更接近于北亚类型族群。闽南人体质介于南亚与北亚类型族群之间,男性相对接近于北亚类型族群,女性相对接近于南亚类型族群。     

Sonography of nasal tip anatomy and surgical tip refinement

The amorphous or wide nasal tip is the most commonly encountered nasal tip deformity, but little has been done to measure the effect of standard rhinoplasty techniques on nasal tip width. In the clinical routine, nasal tip width and soft-tissue cover thickness are estimated by inspection and palpation rather than by measurement. In this study, a B-mode sonograph with a 12-MHz transducer was used in a noncontact mode to measure tip width 0.5 cm occipital to the tip defining point, distance between the alar cartilage domes, and thickness of the soft-tissue cover overlying the lower lateral cartilages. These parameters were measured 3 to 8 weeks before and 56 days to 19 months after a transdomal suture tip plasty in 18 patients. The distance between the alar cartilage domes seemed to be an important factor for tip width because interdomal distance, not soft-tissue cover thickness, correlated with tip width before surgery (correlation: 0.53). Conversely, the degree of tip refinement correlated with preoperative soft-tissue cover thickness (correlation: 0.75), but not with interdomal distance. Ultrasonic imaging of nasal soft tissues may help to assess the effect of different tip refining procedures and other soft-tissue changes after rhinoplasty.     

Alar rim deformities

Alar disharmony is one of the most common abnormalities observed after a rhinoplasty. This article describes three classes in addition to Gunter's classifications of alar/columella deformities, which include concave ala, convex ala caused by convex lateral crus, and convex ala caused by thick alar tissues. These deformities are best visualized from the basilar view. The different surgical techniques for correction of true alar abnormalities are presented. The alar convexity, when it is the result of a misshapen cartilage, is corrected using a lateral crura spanning suture, posterior transection of the lateral crura, or transdomal suture. A thick ala, resulting in convexity, can be thinned through either a direct incision on the ala or an incision in the alar base. A lateral crura strut, an onlay graft, or a rim graft eliminates the concavity. For a slight retraction, an alar rim cartilage graft is an optimal choice. For significant alar retractions, the author's preferred technique is an internal V-to-Y advancement, which is described in detail. An elliptical excision of the alar lining will effectively correct the hanging ala. These techniques have been used to correct alar disharmonies on 58 patients. One patient from the V-Y advancement group exhibited a small area of alar necrosis, and two early patients demonstrated an overcorrection; all were easily resolved with revision surgery. By carefully identifying nasal base and alar abnormalities, harmony can be established to correct an undesirable appearance.     

Effect of face lift on earlobe ptosis and pseudoptosis

The authors have previously described a classification system for earlobe ptosis and established criteria for earlobe pseudoptosis. Earlobe heights were characterized on the basis of anatomic landmarks, including the intertragal notch, the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek skin), and the subaurale (the most caudal extension of the earlobe free margin). The classification system was derived from earlobe height preferences as determined by a survey of North American Caucasians and identified the ideal free caudal segment (otobasion inferius to subaurale distance) measuring 1 to 5 mm (grade I ptosis). Also, earlobe pseudoptosis was defined by an attached cephalic segment (intertragal notch to otobasion inferius distance) measuring greater than 15 mm. In this study, the authors evaluated the effects of standard face lift surgery on earlobe ptosis and pseudoptosis by comparing the preoperative and postoperative earlobe height measurements from life-size photographs of 44 patients who underwent rhytidectomy performed by the senior author. The postoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 12.22 +/- 0.364 mm) increased over its preoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 11.10 +/- 0.406 mm) (p = 0.041). The postoperative free caudal segment (otobasion inferius to subaurale distance, 6.32 +/- 0.438 mm) demonstrated only a trend toward decreased heights when compared with the preoperative free caudal segment (otobasion inferius to subaurale distance, 7.15 +/- 0.489 mm) (p = 0.210). The incidence of pseudoptosis, defined by an attached segment (intertragal notch to otobasion inferius distance) greater than 15 mm, increased from 12.3 percent of preoperative patient earlobes to 17.3 percent of postoperative patient earlobes. An ideal free caudal segment (otobasion inferius to subaurale distance), defined by a range of 1 to 5 mm, was observed in only 37.0 percent of postoperative earlobes versus 22.2 percent of preoperative earlobes. Significant increases in the attached cephalic segments (intertragal notch to otobasion inferius distance) following rhytidectomies correlated with increased incidence of earlobe pseudoptosis, as observed in 17.3 percent of postoperative patient earlobes. Because the free caudal segment was negligibly affected by rhytidectomy, a majority of earlobes (63.0 percent) demonstrated persistent nonoptimal free caudal segment heights (otobasion inferius to subaurale distance > 5 mm). Earlobe height changes can result from either age-related lobule ptosis (increase in free caudal segment) as previously described or in patients undergoing rhytidectomy (increase in attached cephalic segment). Therefore, ideal lobule distances along with the effects of aging and rhytidectomy surgery on the lobule should be discussed with patients who are seeking a more youthful facial appearance, so that the aging ear may be addressed concurrently with the aging face.     

Prospective anthropometric analysis of sagittal orbital-globe relationship following fronto-orbital advancement in childhood

Fronto-orbital advancement is a common procedure for correction of supraorbital retrusion in patients with coronal craniosynostosis. The aim of this study was two-fold: to quantitate change in the sagittal orbital-globe relationship following fronto-orbital advancement in childhood and to determine the ratio of skeletal-to-soft tissue movement. Soft-tissue points on the orbital rim, orbitale superius (os), orbitale laterale (ol), orbitale inferius (oi), and nasion (n), referenced to apex corneae (ac), were measured preoperatively and postoperatively by a custom-made anthropometer. Intraoperative bony advancement was measured with a caliper. Patients were selected with uniform advancement at the fronto-nasal suture and laterally at the mortise and tenon. Fifteen patients with syndromic craniosynostosis were included in the study (six male, nine female): Apert (n = 2), Crouzon (n = 5), Pfeiffer (n = 4), Saethre-Chotzen (n = 3), and Boston type (n = 1). Average age at operation was 8.7 years (range, 4.5 to 10.5 years). Age, sex, method of fixation, postoperative interval, diagnosis, and skeletal movement were analyzed for possible effect on the magnitude of soft-tissue advancement. Average intraoperative skeletal advancement was 12.1 mm, and average postoperative soft-tissue movement was 10.3 mm (p < 0.001), measured at the midpoint of the supraorbital rims (os). The soft tissue: skeletal movement ratio was 0.9:1. Os was the only point at which soft-tissue advancement could be predicted (Spearman's rank correlation coefficient = 0.67); soft-tissue changes at ol, oi, and n were unpredictable. Skeletal movement was the only determinant of soft-tissue advancement of all variables tested, i.e., diagnosis, age, sex, previous fronto-orbital advancement, and wire versus plate fixation. We make recommendations for calculating the magnitude of fronto-orbital advancement, based on preoperative anthropometry and a soft-to-hard tissue advancement factor.     

The relationship between insulin sensitivity and serum adiponectin levels in three population groups.

Reduced plasma adiponectin levels are associated with insulin resistance. Black South Africans, like African Americans, are more insulin-resistant than BMI-matched white subjects, as are Asian Indians. We investigated whether this interethnic variation in insulin resistance is due to differences in plasma adiponectin levels. Blood and anthropometric measurements were taken from black, white and Asian-Indian subjects. Serum adiponectin, lipids, glucose and insulin were measured; insulin sensitivity was calculated using HOMA. Black (HOMA = 2.62 +/- 0.99) and Asian-Indian subjects (HOMA = 3.41 +/- 2.85) were more insulin-resistant than BMI-matched white (HOMA = 1.76 +/- 0.63) subjects (p = 0.0001). Furthermore, the white subjects had higher adiponectin levels (8.11 +/- 4.39 microg/ml) compared to black (5.71 +/- 2.50 microg/ml) and Asian Indian (5.86 +/- 2.50 microg/ml) subjects (p = 0.003). When all ethnic groups were combined, multiple regression analysis demonstrated that serum adiponectin levels corrected for BMI and ethnicity did not correlate with HOMA, but did explain 10.0 % of the variance in HDL-cholesterol levels. Within each ethnic group, adiponectin only correlated inversely with HOMA in white subjects. Adiponectin may play a role in determining serum HDL-cholesterol levels, but ethnic variation in insulin sensitivity is not dependent on serum levels of this adipokine. The relationship between adiponectin and insulin resistance varies across ethnic groups.     

Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases.

For this article, 178 consecutive cases of mandibular reconstruction using microvascular free flaps and performed from 1979 to 1997 were studied. The purpose of this report is to compare flap success rates, complications, and aesthetic and functional results. The ages of the 131 men and 47 women ranged from 13 to 85 years, with an average of 55 years. Donor sites included the rib (11 cases), radius (one case), ilium (36 cases), scapula (51 cases), fibula (34 cases), and soft-tissue flaps with implant (45 cases). Complications included total flap necrosis, partial flap necrosis, major fistula formation, and minor fistula formation. The rate of total flap necrosis involving the ilium and fibula was significantly higher than that of all other materials combined (p < 0.05). The overall rate of implant plate removal, which resulted from the exposure or fracture of the plate, was 35.6 percent (16 of 45 cases).Each mandibular defect was classified by the extent of the bony defect and by the extent of the soft-tissue defect. The extent of the mandibular bony defect was classified according to the HCL method of Jewer et al. The extent of the soft-tissue defect was classified into four groups: none, skin, mucosal, and through-and-through. According to these classifications, functional and aesthetic assessments of deglutition and contour were performed on 115 subjects, and speech was evaluated in 110. To evaluate the postoperative results, points were assigned to each assessment of deglutition, speech, and mandibular contour. Statistical analysis between pairs of bone-defect groups revealed that there was no significant difference in each category. Regarding deglutition, statistical analysis between pairs of soft-tissue-defect groups revealed there were significant differences (p < 0.05) between the none and the mucosal groups and also between the none and the through-and-through groups. Regarding speech, there was a significant difference (p < 0.05) between the none and the through-and-through groups. Regarding contour, there were significant differences (p < 0.01) between the none and the through-and-through groups and between the mucosal and the through-and-through groups. The points given for each function, depending on the reconstruction material, revealed that there was no significant difference between pairs of material groups.From this prospective study, the authors have developed an algorithm for oromandibular reconstruction. When the bony defect is lateral, the ilium, fibula, or scapula should be chosen as the donor site, depending on the extent of the soft-tissue defect. When the bony defect is anterior, the fibula is always the best choice. When the soft-tissue defect is extensive or through-and-through with an anterior bony defect, the fibula should be used with other soft-tissue flaps.     

Alleles and haplotypes of tumor necrosis factor (TNF) alpha and beta genes in three ethnic populations of Sulawesi Indonesia

Polymorphic variation in two cytokine genes, tumor necrosis factor (TNF) -alpha and -beta, was examined in three ethnic groups, the Bugis, the Makassans, and the Torajans, who inhabit Sulawesi, a large island in the Indonesian archipelago, and formerly a Dutch colony. TNF-alpha and -beta are key molecules in immune responses to infection, and both have been implicated in the pathogenesis and clinical manifestations of parasitic diseases. Several polymorphic variants with the potential to affect cytokine levels in autoimmune diseases and parasitic and bacterial infection have been reported. Two loci in the promoter region of TNF-alpha and two sites in the first intron of TNF-beta were scored in a maximum of 150 Bugis, 168 Makassans, and 58 Torajans. Genotypes at the two TNF-alpha loci are not in Hardy-Weinberg equilibrium because of a deficit of heterozygotes (p < 0.05). However, genotypes at the TNF-beta loci exhibit Hardy-Weinberg equilibrium. A comparison of allelic and genotypic frequencies at all TNF loci across the ethnic groups reveals that the differences are significant for TNFalpha(308) (p < 0.01) and for TNFbeta(NcoI) (p < 0.05). Overall, the distribution of the alleles differs from that seen in the few Asian populations for which data are available (p < 0.05). Construction of 4-locus haplotypes showed that, in addition to the five previously reported, four novel haplotypes were present in Sulawesi. These novel haplotypes were in low frequency, and two were seen only in Bugis (haplotypes F and J) and one (haplotype K) only in Makassans. The other, haplotype D, was present in Makassans and Torajans. Preliminary sampling of other ethnic groups suggests that three of these haplotypes (D, F, and J) may be restricted to Asian or Asian-derived populations. The frequency of the common TNF haplotypes differed between Dutch and Sulawesi populations, and these data also indicated that haplotype E, which has a relatively high frequency in the Dutch (25%), may be a useful marker of Dutch/European admixture in Indonesian populations, in which it is either rare (1%) or absent. The results suggest that unique allelic combinations with potential to influence cytokine secretion are present in Sulawesi, possibly as a consequence of parasite-driven selection, and argue for more extensive investigation of haplotype distribution in parasite-endemic areas.     

Beyond Socioeconomics: Explaining Ethnic Group Differences in Parenting Through Cultural and Immigration Processes

This study examined both socioeconomic and cultural factors in explaining ethnic differences in monitoring, behavioral control, and warmth—part of a series of coordinated studies presented in this special issue. Socioeconomic variables included mother's and father's educational levels, employment status, home ownership, number of siblings in the household, and single parent status. Cultural factors included nationality or ethnicity, immigrant status of child, mother's/father's age of arrival in the United States, mother's/father's English language use with the child, child's native fluency, and cultural values for independence and interdependence. The sample consisted of 591 European American, 123 African American, 1,614 Asian American, and 597 Latino students in the ninth grade. All the ethnic minority groups were higher than European Americans on behavioral control, and Latinos were also higher than European Americans on monitoring. However, European Americans were higher on parental warmth than Asian Americans and African Americans. These ethnic group differences primarily remained even after controlling for the socioeconomic factors. Finally, in analyses looking within the Asian and Latino groups, differences in parenting were found within both groups due to nationality or ethnicity, youth's fluency in the native language, and cultural values of interdependence, although values of independence were also related to the parenting of Asian Americans.     

Diencephalic neuronal populations projecting axons into the basal plate in a lizard (Gallotia galloti).

Lizard diencephalic populations sending axons into the basal plate were studied by the in vitro HRP technique in the lizard Gallotia. Retrograde labeled cells were concentrated in distinct neuronal groups within alar plates of prosomeres p1 and p3, whereas the alar plate of p2 was poorly labeled. Efferent fibers from alar p1 and p3 populations entered the basal plate of the diencephalon along topologically dorsoventral courses, bifurcating thereafter into longitudinal ascending (rostral) and descending (caudal) trajectories. Thus, diencephalic segments p1 and p3 have alar cell populations contributing to the longitudinal premotor connectivity of the neural axis , whereas the alar p2 segment projects via the fasciculus retroflexus, the efferent tract of the epithalamus. However, the axons from the habenular complex bifurcate within or adjacent to the floor plate and not within the basal plate.     

Bilateral eccentric and concentric torque of quadriceps and hamstring muscles in females and males

This study assessed maximum eccentric (ECC) and concentric (CON) torque of quadriceps (QUAD) and hamstring (HAM) muscle groups in healthy females (n = 13) and males (n = 27). Peak torques (PT) of bilateral muscle actions were recorded at constant angular velocities of 0.52, 1.57 and 2.61 rad.s-1. The QUADCON and HAMCON PT decreased (p less than 0.05) with increasing angular velocity. The QUADECC and HAMECC PT increased (p less than 0.05) in females, whereas QUADECC PT decreased (p less than 0.05) and HAMECC PT showed no change in males. In general, ECC PT was higher (p less than 0.05) than CON PT and QUAD PT was higher (p less than 0.05) than HAM PT, for any given angular velocity. Males displayed higher (p less than 0.05) PT than females but when PT were adjusted for body mass the sex differences in QUADCON and HAMCON were reduced (p less than 0.05), whereas the differences in QUADECC and HAMECC were abolished. The CON and ECC PT were, on average, 60% and 41% greater, respectively, in males than in females. The corresponding differences, when adjusted for body mass, were 23% and 8%. ECC:CON PT for QUAD were higher (p less than 0.05) in females than in males. CON and ECC HAM:QUAD PT ratio increased (p less than 0.05), as a function of velocity. This study suggests, that bilateral ECC PT is higher than CON PT and CON HAM:QUAD PT ratio is higher than ECC HAM:QUAD PT ratio.(ABSTRACT TRUNCATED AT 250 WORDS)     

Genes, diet and serum lipid concentrations: lessons from ethnically diverse populations and their relevance to coronary heart disease in Asia

PURPOSE OF REVIEW: The burden of coronary heart disease (CHD) in Asia has risen in tandem with socio-economic development and urbanization. Although all ethnic groups have been affected, some appear to be at particularly high risk. The basis of these ethnic differences remains poorly understood. RECENT FINDINGS: Differing levels of risk factors for CHD have been observed between ethnic groups. Previous studies, however, may be confounded by a large ethnic variation in socio-economic status and place of residence. Few studies have taken dietary factors into account. Recent studies involving Chinese, Malays and Asian Indians living in Singapore suggest that neither dietary nor genetic factors, taken in isolation, sufficiently explain ethnic differences in serum lipid profiles. Several genetic variants in key candidate genes (apolipoprotein E, APOE, cholesteryl ester transfer protein, CETP and hepatic lipase, LIPC) have recently been found to modulate the association between dietary factors and serum lipid concentrations in these ethnic groups and in other populations. SUMMARY: To fully evaluate the differences in CHD risk between ethnic groups, environmental exposures, including dietary factors need to be carefully evaluated, and gene-environment interactions that may give rise to these differences need to be taken into account. These are critical steps in the development of targeted strategies to contain the epidemic of coronary heart disease in Asia. An understanding of the basis of these differences may also provide insights into the pathogenesis of disease that one cannot get through the examination of more homogenous populations.