Dissertations / Theses on the topic 'Secondary Palate'

Objetivos: Verificar o efeito da veloplastia intravelar associada à palatoplastia secundária sobre a fala de pacientes com insuficiência velofaríngea (IVF), e comparar os resultados de fala entre os pacientes, de acordo com a extensão da falha no fechamento velofaríngeo aferida pela nasofaringoscopia. Modelo: Estudo prospectivo em pacientes com fissura palatina operada e IVF residual, avaliados 3 dias, em média, antes e 8 meses, em média, após a cirurgia, divididos em 2 grupos: um com falhas pequenas e outro com falhas de tamanho médio a grande no fechamento velofaríngeo. Diferenças entre grupos e etapas foram consideradas significantes ao nível de 5%. Local de Execução: Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP). Participantes: 40 pacientes, de ambos os sexos, com idade entre 4 e 48 anos, sendo 25 com falhas pequenas (grupo I) e 15 com falhas médias ou grandes no fechamento velofaríngeo (grupo II). Variáveis: Hipernasalidade, emissão de ar nasal, distúrbios articulatórios compensatórios e função velofaríngea avaliados por meio de avaliação perceptiva da fala e nasalância obtida por meio da nasometria. Resultados: Após a cirurgia, verificou-se no grupo I, eliminação da hipernasalidade, emissão de ar nasal e distúrbio articulatório compensatório em 64%, 64% e 20% dos pacientes respectivamente. Em 44% dos casos deste grupo, a função velofaríngea passou a ser adequada e, também, em 44% houve normalização dos valores de nasalância. No grupo II verificou-se eliminação da hipernasalidade em 13%, da emissão de ar nasal em 20% e do distúrbio articulatório compensatório em 7%. Somente 7% dos pacientes deste grupo passaram a apresentar função velofaríngea adequada e em 14% houve normalização da nasalância após a cirurgia. Conclusões: A curto prazo, a veloplastia intravelar associada à palatoplastia secundária levou à melhora dos sintomas de fala da IVF na maioria dos pacientes estudados. Os resultados mostraram, ainda, que a cirurgia levou à melhora mais expressiva nos pacientes que apresentavam falhas no fechamento velofaríngeo de pequena extensão.<br>Objectives: To verify the effect of intravelar veloplasty associated with secondary palatoplasty on the speech of patients with velopharyngeal insufficiency (VPI) and to compare the speech outcomes among these patients, according to the extent of defect of velopharyngeal closure as analyzed by nasopharyngoscopy. Model: Prospective study of patients with repaired cleft palate and residual VPI, evaluated at 3 days before and 8 months after surgery in the average, who were divided into two groups: one with minor defect and the other with medium to large defect in velopharyngeal closure. Differences between groups and stages were considered significant at the 5% level. Setting: Laboratory Physiology of Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP). Participants: 40 patients of both genders, aged 4 to 48 years old, being 25 with minor defects (group I) and 15 with medium to large defects (group II) in velopharyngeal closure. Variables: Hypernasality, nasal air emission, compensatory articulation production and velopharyngeal function, evaluated by perceptive evaluation of speech and nasalance obtained by nasometry. Results: After surgery, group I exhibited elimination of hypernasality, nasal air emission and compensatory articulation production in 64%, 64% and 20% of patients, respectively. Adequate velopharyngeal function and normalization of nasalance values were observed in 44% of cases in this group. Group II presented elimination of hypernasality in 13%, nasal air emission in 20% and compensatory articulation production in 7%. Only 7% of patients in this group presented adequate velopharyngeal function and 14% exhibited normalization of nasalance after surgery. Conclusions: In the short term, intravelar veloplasty associated with secondary palatoplasty led to improvement in VPI-related speech symptoms in most patients. The results further demonstrated that surgery allowed greater improvement in patients presenting minor defects in velopharyngeal closure.

Objetivo: Comparar os resultados de hipernasalidade, nasalância e função velofaríngea entre duas técnicas cirúrgicas que empregam o procedimento de veloplastia intravelar para a correção da insuficiência velofaríngea (IVF) residual: a palatoplastia posterior secundária com manobra de Braithwaite e a palatoplastia posterior secundária pela técnica de Furlow. Modelo/Participantes: Estudo prospectivo em 50 pacientes com IVF residual, que realizaram a veloplastia intravelar, tendo sido divididos em dois grupos: 31 pacientes submetidos à palatoplastia posterior secundária com manobra de Braithwaite (grupo B) e 19 pacientes submetidos à palatoplastia posterior secundária pela técnica de Furlow (grupo F). Local de Execução: Laboratório de Fisiologia do Hospital de Reabilitação de Anomalias Craniofaciais-USP. Variáveis: Hipernasalidade, classificada perceptivamente por três avaliadores; nasalância, determinada por meio da nasometria e, fechamento velofaríngeo, estimada pela medida da área velofaríngea, por meio da técnica fluxo-pressão, em média, 3 dias antes e 14 meses após a cirurgia. Resultados: Verificou-se, após a cirurgia, redução da hipernasalidade e da nasalância em 45% e 65% dos casos, respectivamente e, melhora do fechamento velofaríngeo em 50% dos pacientes do grupo B. Para o grupo F, observou-se redução tanto da hipernasalidade quanto da nasalância em 53% dos pacientes e melhora do fechamento velofaríngeo em 46% dos casos. Diferenças estatisticamente significantes não foram identificadas entre as duas técnicas cirúrgicas para todas as variáveis estudadas (p<0,05). Conclusão: Os achados permitiram concluir que as duas técnicas cirúrgicas que empregam o procedimento de veloplastia intravelar mostraram resultados semelhantes na redução dos sintomas da IVF residual.<br>Objective: To compare postoperative outcomes of hypernasality, nasalance and velopharyngeal function between two surgical techniques that use intravelar veloplasty procedure for velopharyngeal insufficiency (VPI) management: secondary palatoplasty as suggested by Braithwaite and secondary palatoplasty by Furlow technique. Model/Participants: Prospective study in 50 patients with VPI, underwent intravelar veloplasty divided into two groups: 31 patients underwent secondary palatoplasty as suggested by Braithwaite (group B) and 19 patients underwent secondary palatoplasty by Furlow technique (group F). Setting: Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais-USP. Variables: Hypernasality, perceptually classified by three evaluators; nasalance determined by means of nasometry and velopharyngeal function, assessed by means of velopharyngeal area measurement provided by the pressure-flow technique, 3 days before and 14 months after surgery, on average. Results: After surgery, reduction of hypernasality and nasalance was verified in 45% and 65% of cases, respectively, and improvement of velopharyngeal closure in 50% of patients in group B. In group F, reduction of hypernasality and nasalance was observed in 53% of patients and improvement of velopharyngeal closure in 46% of cases. No statistically significant differences were identified between the two surgical techniques for all variables studied (p<0,05). Conclusion: The two surgical techniques involving intravelar veloplasty procedure showed similar results in reducing VPI symptoms.

Aim: The aim of this literature study was to systematically review the scientific evidence on the most effective donor sites and/or bone substitute material for secondary alveolar cleft grafting in alveolar cleft patients. Material and method: In order to acquire a systematic and transparent reporting this literature review was conducted according to the PRISMA statement. The literature search was performed in the following four databases; PubMed, CENTRAL, Web of Science and Scopus.The quality of the included studies was assessed using the revised Cochrane Risk of Bias 2 tool (RoB 2 tool). Result: The search identified 4754 studies. Five RCT studies was included in this systematic review and assessed different donor site or bone substitute materials. Two studies showed low risk of bias and three moderate risk of bias. Only one study showed a statistically significant difference when comparing iliac bone to substitute material however all studies presented substitute materials with satisfactory results. Conclusion: According to the data from this systematic review no clear conclusion can be drawn regarding what the most effective bone donor site and/or tissue engineered bone substitute material to use in secondary bone grafts. Based on the available evidence iliac bone could still be regarded as a benchmark, but more research and RCT’s of high quality are required, especially for artificial bone substitute materials.<br>Syfte: Syftet med denna litteraturstudie var att systematiskt granska den vetenskapliga evidensen gällande det mest effektiva bentagningsstället och/eller bensubstitutmaterialet vid sekundär bentransplantation hos patienter med käkspalt. Material och metod: För att uppnå en systematisk och transparent rapportering av denna litteraturstudie följdes PRISMA statement. Litteratursökningen gjordes i följande fyra databaser; PubMed, CENTRAL, Web of Science och Scopus. Kvaliteten av inkluderade studier granskades med hjälp av Cochrane Risk of Bias 2 tool (Rob 2 tool). Resultat: Sökningen identifierade 4754 studier. Fem RCT studier inkluderades i denna systematiska översikt vilka värderade olika bentagningsställen eller bensubstitut. Två studier bedömdes ha låg risk för bias och tre artiklar måttlig risk för bias. Endast en studie visade på en statistiskt signifikant skillnad vid jämförelse av höftben med bensubstitut däremot presenterade samtliga studier substitutmaterial med tillfredsställande resultat. Konklusion: Denna systematiska översikt visade att ingen klar slutsats kan dras gällande vilken det mest effektiva bentagningsstället eller bensubstitutsmaterialet är för sekundär bentransplantation hos patienter med käkspalt. Baserat på tillgänglig evidens kan transplantat från höftbenet fortfarande anses vara bäst lämpat men mer forskning samt RCT studier av hög kvalité erfordras, särskilt för artificiella bensubstitutmaterial.

Patienten mit Lippen-Kiefer-Gaumenspalten weisen häufig ein ästhetisches Defizit im Bereich der Nase auf und müssen sich nach Wachstumsabschluss nicht selten einer Nasenkorrektur unterziehen. Die in der Literatur publizierten Ergebnisse von Spaltnasenkorrekturen sind zum Teil kontrovers und bilden verschiedene Blickwinkel ab. Bewertungen von Patienten und Therapeuten unterscheiden sich mitunter erheblich. Ziel dieser retrospektiven Studie war es, zu ermitteln, welche funktionellen und ästhetischen Resultate mit Hilfe der Sekundärkorrektur der spaltbedingten Nasendysplasie zu erzielen sind und wie sich der Blickwinkel der Patienten von denen professioneller Juroren unterscheidet. Hierfür konnten 242 Patientinnen und Patienten mit Lippen-Kiefer-Gaumenspalten eingeschlossen werden, welche sich im Zeitraum vom 01.01.2001 bis 31.12.2013 an der Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie des Universitätsklinikums Leipzig einer sekundären Rhinoplastik unterzogen hatten. Aus Sicht der Patienten wurde hinsichtlich der Funktion in 82% der Fälle ein gutes Ergebnis erreicht. Bezüglich der Ästhetik beurteilten die Patienten das Ergebnis zu 74% als gut und zu 21% als moderat. Die identische Befragung der professionellen Jury ergab in 65% der Fälle die Einschätzung gut und in 26% der Fälle die Bewertung moderat. Die vergleichende statistische Analyse der Einschätzungen der beiden Kollektive ergab eine nur geringe Interrater-Reliabilität. Die Ergebnisse der Studie zeigen, dass in der Mehrzahl der Fälle gute Resultate erzielbar sind. Die Bewertungen der Patienten und jene der Ärzte differieren dabei deutlich.

Polar organic molecules are defined by differences in electronegativity between their atomic constituents and the resulting asymmetrical structures. They represent the basic chemical building blocks of life. Having a strong affinity to water (H[subscript]2O), which is essential for life on Earth, polar molecules are studied by the discipline of biochemistry and their origin, distribution, and function in living systems is relatively well understood. Polar constituents of sedimentary organic matter and petroleum have been previously studied but they are, in general, yet far from being understood. They can be present as primary biogenic molecules, rearranged biogenic molecules, or secondary functionalized hydrocarbons. The studies compiled in this thesis use selected polar organic compounds as molecular tools: phospholipids as indicators of biomass, high-molecular-weight polycyclic aromatic hydrocarbons as combustion markers, phenols as indicators of oil-water interaction processes, and carboxylic acids in general.Chapter 2 studies the biological oxidation of petroleum accumulations; a process mediated by microbes that inhabit the deep subsurface and affect the long-term storage of living carbon as sedimentary biomass of the ‘deep biosphere’. The results presented in chapter 2 suggest that intact bacterial cells are present in biodegraded petroleum, as indicated by the detection of membrane lipid fragments, termed phospholipids, in these oil samples. Carboxylic acids released from phospholipids (i.e. phospholipid fatty acids, PLFA) in oil samples vary in concentration (~2.0 - ~10.0 µg/g oil) and composition (i-C[subscript]14:0 dominated vs. i-C[subscript]15:0 and i-C[subscript]17:0 dominated) during progressive petroleum biodegradation, thereby showing that the microbial community increases in size during the removal of petroleum constituents, and that the community structure changes. Not one but at least two structurally different microbial consortia are shown to be responsible for petroleum degradation. Chapter 4 evaluates the rapid oxidation of biomass during the impact of an extraterrestrial bolide, which occurred during the late Neoproterozoic.The co-occurrence of a -3.5‰ negative sedimentary stable carbon isotope excursion and a molecular combustion-marker anomaly (coronene; 0.48 ppb, relative to a 0.04 ppb background), which are followed by a diversification of Acritarch species, suggests that combustion of ‘early’ terrestrial and marginallymarine biomass might have caused extensive smoke and atmospheric dimming, as well as subsequent photosynthetic stress. Moreover, the sharp combustion marker anomaly can probably provide a long-sought chronostratigraphic marker for the late Neoproterozoic, when also detected in other locations around the globe. Chapter 5 evaluates the effects of petroleum interaction with water. For this purpose oils produced from one reservoir were monitored during a 335-day period following the rationale that oil-water interaction increases during petroleum production. Based on a selective depletion of volatile aromatics and invariant phenol concentrations the results exclude both evaporative and oil-water partitioning processes. Petroleum compositional changes, recorded mainly in the low-molecular-weight aromatic and phenol fractions, were tentatively attributed to abiotic oxidation processes. Furthermore, methodological advances in the analysis of carboxylic acids of low molecular weight, evaluated for the execution of the other studies, are presented in chapter 4.Overall, the presented results shed more light on carbon export fluxes from different sedimentary carbon reservoirs by shedding new light on deep biosphere metabolism, elucidating the significance of the Neoproterozoic Acraman impact event, and contributing to our knowledge of petroleum destruction through its interaction with water in sedimentary basins. Moreover, they show that, in contrast to traditional belief, NSO compounds in oils and bitumens can form useful molecular tools to study questions in petroleum geochemistry, biogeochemistry, and palaeobiogeochemistry. Understanding the size of carbon reservoirs and fluxes on Earth, as well as the mechanisms that cause these carbon fluxes, can increase our appreciation of global biogeochemical cycling and, in turn, explain ecosystem dynamics, past evolutionary events, and predict future change of current climatic conditions.

La suture palatine médiane provient, embryologiquement d'une part du bourgeon médian qui va donner notamment le palais primaire (5ème semaine) et d'autre part des processus palatins latéraux, issus de la face profonde des bourgeons maxillaires qui vont réaliser le palais secondaire (6ème - 12ème semaine). Ainsi, les zones de fusion, de type synfibrose, des différents éléments vont donner la suture palatine médiane. L'enjeu de ce travail est de connaître l'évolution de la synfibrose de la suture palatine médiane. L'étude est composée de deux parties : radiologique, surtout, examens de scanners des sinus maxillaires chez l'enfant et l'adulte et histologique, étude de pièces anatomiques de palais chez le foetus, l'embryon, l'adulte et l'animal. Les résultats montrent qu'il n'existe pas d'âge de fermeture complète de la suture palatine médiane. Egalement, ils révèlent que les palais primaire et secondaire évoluent séparément : selon l'axe antéropostérieur, le secondaire se ferme d'avant en arrière et généralement après la fermeture du primaire et selon l'axe vertical, le palais primaire se ferme de bas en haut tandis que le palais secondaire de haut en bas. Il est difficile de transposer ces résultats en orthopédie dentofaciale puisque la disjonction de la suture palatine médiane est essentiellement orthodontique et rarement chirurgicale (après l'âge de 14-16 ans). Mais, deux explications peuvent être avancées : l'existence au niveau de la suture d'un tissu osseux "" jeune et lâche""permettant une disjonction orthodontique ou ""âgé et dense"" obligeant un acte chirurgical, plus ou moins associée à une absence de fermeture de la suture non visible radiologiquement. Néanmoins, un scanner peut être utile en cas de disjonction chirurgicale afin de guider le chirurgien sur la profondeur de l'ostéotomie<br>In embryology, the mid palatal suture comes from the median bud which will give, including, the primary palate (5th week) and the lateral palatine process, issued from the deep surface of the maxillary buds which will create the secondary palate (6th ?€? 12th week). Thus, the areas of mergers, type synfibrosis, different elements will give the mid palatal suture. The challenge of this study is to know the development of the synfibrosis of this suture. The work is composed of two parts : radiologic, especially, reviews of CT scanners of maxillary sinus in children and adults and histologic, study anatomical parts of palates in the fetus, embryo, adult and animal. The results show that there is no age for a complete closure of the mid palatal suture. Also, they show that the primary and secondary palates evolve separately : for anterior-posterior axis, the secondary closes from front to back and usually after the closure of the primary and for vertical axis, the primary palate closes from bottom to top, whereas the secondary palate, from top to bottom. It is difficult to translate these results in dentofacial orthopedic since the disjunction is mainly orthodontic and rarely surgical (after the age of 14-16). But, two explications can be explained : the existence at the suture, a bone tissue "young and low" which allows a orthodontic separation or "old and dense" requiring surgical procedure, more or less with a lack closure of the suture not visible radioactively. Nevertheless, a scanner can be useful in a surgical disjunction to guide the surgeon on the depth of the osteotomy

Cleft palate is one of the most common congenital malformations in humans which occurs at a frequency of approximately 1:700 live births worldwide. Sine Oculis-related homeobox 2 (Six2) is a member of the vertebrate Six gene family that encode proteins that are transcription factors. Six2 has been reported to be a downstream target of Homeobox a2 (Hoxa2), a gene that plays a direct a role in mouse secondary palate (SP) development. In my thesis, I utilized quantitative real time Polymerase Chain Reaction (qPCR), Western blot analysis and fluorescence immunohistochemisrty (IHC) to characterize the spatial and temporal distribution patterns of Six2 in the developing SP. Additionally, I also employed in vivo cell counting analysis and in vitro cell proliferation assays to investigate the role of Six2 during palate mesenchymal cell proliferation. My study examined the temporal and spatial distribution of Six2 in the developing mouse palatal mesenchyme and epithelia in both wild-type and Hoxa2 null mice. Six2 was expressed throughout the period of embryonic palatogenesis, with the highest levels of Six2 mRNA and protein observed in palatal shelves at E13.5 in both wild-type and Hoxa2 null mice. Six2 protein expression at all stages of SP development (E12.5 to E15.5) increased in the anterior to posterior (A-P) direction with highest expression in the posterior regions of the developing SP. In addition, expression of Six2 protein was higher in the oral half of the palatal mesenchyme compared to the nasal half of the palatal mesenchyme. Interestingly, Six2 protein was expressed in the nasal palatal epithelium but was completely absent from the oral palatal epithelium. Loss of the Hoxa2 gene induced up regulation of Six2 protein and mRNA in the developing palate across all stages of palatogenesis. In the Hoxa2 null mice, there was a significant increase in cell proliferation (Ki-67 positive cells) and the percentage of actively proliferating cells that were co-expressing Six2 protein (Six2/Ki-67 double positive cells) along both the A-P and oral-nasal (O-N) axes of the developing SP. Also, the highest percentage of actively proliferating cells and Six2/Ki-67 double positive cells was observed in the nasal half of the posterior palatal mesenchyme. Furthermore, Six2 siRNA knock down in mouse embryonic palatal mesenchyme (MEPM) cell cultures restored cell proliferation and Cyclin D1 expression in the Hoxa2 null cell cultures to wild-type levels. Collectively, my data reveals a novel spatial and temporal expression profile for Six2 in the developing mouse SP and the potential role it might play during the epithelial-mesenchymal cross talk that drives palatal shelf cell proliferation and out growth.

A study was undertaken to examine whether collagen synthesis is critical for shelf reorientation. In the initial experiments in quail, a dose of 100μg 5-fluorouracil (5-FU) administered on day 4 of incubation was determined to be the best dose-time regimen to induce cleft palate. Pregnant hamsters were given 81mg/kg 5-FU intramuscularly or 1m1 saline on day 11 of gestation. Control and treated embryonic palates dissected from hamsters between days 11 and 13 of gestation, and from quail between days 5 and 10 of incubation, were incubated in a growth medium supplemented with 14C-proline. The samples were used for either: 1. Collagen digestion assay to determine the rate of collagen synthesis; 2.Total protein determination; 3. High performance liquid chromatography (HPLC)to determine hydroxyproline (HYP) levels; or 4. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to determine different collagenisotypes. In addition, embryos from both hamster and quail were processed for light microscopy (LM). The LM results showed that, in hamster 5-FU induces cleft palate by delaying the reorientation of palatal shelves, while in quail the drug widened the gap between the palatal shelves. The data on collagen synthesis showed that in control hamster a spurt in the collagen synthesis was seen in palate between days 12:00 (12 day: 0 hour) and 12:04 of gestation, which is the period of shelf reorientation. In 5-FU exposed hamster palates, the rate of collagen synthesis was lower than controls until day 12:04 of gestation followed by a spurt on day 12:12 of gestation. In 5-FU-treated embryos palatal shelf reorientation took place between days 12:16 and 13:00 of gestation. In the developing secondary palate of both the control and 5-FU- treated quail, the rate of collagen synthesis peaked on day 8 of incubation. The collagen synthesis, however, was lower in 5-FU-treated than in the control palates. HYP levels in both control and 5-FU-treated hamster palate indicated that although an equal amount of new collagen was synthesized in both groups, the shelf reorientation was delayed in the drug-treated embryos. The HYP data from control and 5-FU-treated quail indicated that, in addition to new collagen a considerable amount of non-collagenous protein may also have been synthesized during quail palate morphogenesis. SDS-PAGE showed that only type I collagen was synthesized during palate development in both the control and 5-FU-treated hamster and quail. It was suggested that since (1) in birds, a spurt in collagen synthesis occurs in the absence of shelf reorientation, (2) an equal amount of new collagen was synthesized in both the control and 5-FU-treated hamster embryos during the period of normal reorientation, and (3) in 5-FU-treated hamster embryos, are covery in collagen synthesis occurs prior to, and a reduction at the time of initiation of delayed shelf reorientation, collagen synthesis may not cause shelf reorientation in mammals.

碩士<br>長庚大學<br>顱顏口腔醫學研究所<br>102<br>ABSTRACT BACKGROUND: Despite popularity and the well-established procedures of secondary alveolar bone grafting (SABG), not all SABG are successful. We aimed to investigate the radiographic outcome of SABG and its association with a wide range of factors (eg, demographics, surgeon, presurgical and postsurgical cleft status). METHODS: We analyzed postoperative cone beam computed tomographic scans of 77 children with complete unilateral cleft lip and palate (UCLP) who were treated with SABG. Residual cleft defects, unsupported root ratio of central incisors and canines adjacent to clefts, and Bergland scale were measured. Possible influencing factors included sex, age, surgeon, presence of lateral incisor, canine eruption, cleft size, orthodontic treatment, postoperative infection, and duration of follow-up. RESULTS: The oral cleft defect was related to the orthodontic treatment before ( = -119.1, p = 0.001) and after ( = -117.6, p < 0.01) surgery. The nasal cleft defect was related to the sex ( = 82.6, p < 0.05). The sex predicted the unsupported root ratio of the central incisors ( = -0.04, p < 0.01). The Bergland scale was related to the eruption status of the canines at surgery (OR = 0.04, p < 0.01) and the postoperative infection (OR = 15.6, p < 0.05). CONCLUSIONS: The results suggest that in children with UCLP radiographic outcome of SABG was related to the orthodontic treatment, eruption status of cleft-adjacent canines at surgery, postoperative infection, and sex.

A study was undertaken to investigate: (1) the kinetics of cell proliferation; (2) the activity of two protein kinases, MAPK and CK2, that are implicated in the regulation of cell proliferation; (3) the effect of a growth factor, EGF, on the proliferation of cultured quail palate mesenchymal cells (QPMC); and (4) the activity of MAPK and CK2 following E G F treatment of cultured QPMC. Initially, an in vivo/in vitro comparison of developing quail was performed to validate the whole embryo culture technique. The data showed that, on the basis of C R L and developmental staging method, the in vitro (whole embryo culture) embryos developed in a manner similar to their in vivo counterparts. The whole embryo culture was then used to analyze the cell proliferation kinetics by 3H-thymidine autoradiography during quail palate morphogenesis. The results indicated that the rate of cell proliferation declined with the advancing morphogenesis of quail palate. Subsequently, embryonic palates were dissected at 24 hour intervals between days 5 and 9 of incubation and homogenized. Isolated proteins from the homogenate were fractionated by FPLC, and analyzed by phosphotransferase assays, scintillation counting, and Western blotting to detect the presence and activation of two second-messenger independent protein kinases, MAPK and CK2, implicated in the regulation of cell proliferation. The results showed that phosphotransferase activity towards MBP showed a negative, whereas that towards phosvitin showed a positive correlation with proliferation of QPMC. Western blotting indicated that both MAPK and C K 2 were present during quail palate development. Finally, growth behaviour of QPMC in primary cell culture was analyzed. The results showed that the number of Q P M C increased faster in EGF-treated than in control cultures. E G F stimulated phosphotransferase activity towards MBP and phosvitin, and Western blotting indicated that both MAPK and CK2 were activated. It was suggested that both MAPK and CK2 may be involved in growth factor regulated cell proliferation during the palate development.

碩士<br>長庚大學<br>顱顏口腔醫學研究所<br>102<br>Background and Purpose: The role of primary gingivoperiosteoplasty (PGPP) on the repair of alveolar clefts remains controversial. This study therefore aimed to compare the success of PGPP and secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP). Methods: In this prospective study, the postoperative cone-beam computed tomographic scans of 50 children (mean age: 9.8 ± 0.8 years) with complete UCLP who underwent PGPP (n = 25) or SABG (n = 25) were analyzed. Residual cleft defect and unsupported root ratio of cleft-adjacent central incisors were measured and compared between these two methods of alveolar repair. Results: Patients repaired by PGPP presented more need for additional bone grafting than by SABG (28% vs. 4%, p < 0.05). Residual cleft defect and were greater in patients repaired by PGPP than by SABG (305.8 ± 176.5 mm3 vs. 178.6 ± 122.0 mm3, p < 0.05). Patients repaired by PGPP showed more residual palatal coronal and palatal apical defects than by SABG (p < 0.05 and p < 0.001, respectively). Unsupported root ratio of central incisors adjacent to the cleft were not associated with the methods of alveolar repair by PGPP or SABG (1.0 ± 2.9% vs. 1.7 ± 5.2%, p > 0.05). Conclusions: The data suggest that in patients with UCLP, PGPP results in less bone than SABG particularly on the palatal apical portion of the previous alveolar cleft. Clinical success is lower with PGPP when compared with SABG.

Patienten mit Lippen-Kiefer-Gaumenspalten weisen häufig ein ästhetisches Defizit im Bereich der Nase auf und müssen sich nach Wachstumsabschluss nicht selten einer Nasenkorrektur unterziehen. Die in der Literatur publizierten Ergebnisse von Spaltnasenkorrekturen sind zum Teil kontrovers und bilden verschiedene Blickwinkel ab. Bewertungen von Patienten und Therapeuten unterscheiden sich mitunter erheblich. Ziel dieser retrospektiven Studie war es, zu ermitteln, welche funktionellen und ästhetischen Resultate mit Hilfe der Sekundärkorrektur der spaltbedingten Nasendysplasie zu erzielen sind und wie sich der Blickwinkel der Patienten von denen professioneller Juroren unterscheidet. Hierfür konnten 242 Patientinnen und Patienten mit Lippen-Kiefer-Gaumenspalten eingeschlossen werden, welche sich im Zeitraum vom 01.01.2001 bis 31.12.2013 an der Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie des Universitätsklinikums Leipzig einer sekundären Rhinoplastik unterzogen hatten. Aus Sicht der Patienten wurde hinsichtlich der Funktion in 82% der Fälle ein gutes Ergebnis erreicht. Bezüglich der Ästhetik beurteilten die Patienten das Ergebnis zu 74% als gut und zu 21% als moderat. Die identische Befragung der professionellen Jury ergab in 65% der Fälle die Einschätzung gut und in 26% der Fälle die Bewertung moderat. Die vergleichende statistische Analyse der Einschätzungen der beiden Kollektive ergab eine nur geringe Interrater-Reliabilität. Die Ergebnisse der Studie zeigen, dass in der Mehrzahl der Fälle gute Resultate erzielbar sind. Die Bewertungen der Patienten und jene der Ärzte differieren dabei deutlich.:1. Einleitung, historischer Überblick 1 2. Bewertung von Spaltnasenkorrekturen 3 3. Objektive Defizite der Spaltnase 5 3.1. Funktionelle Defizite 5 3.2. Ästhetische Defizite 6 4. Möglichkeiten und Grenzen der Spaltnasenoperation 8 5. Konzept und Fragestellung der Promotion 10 6. Publikation 11 7. Zusammenfassung 19 8. Anhang 21 8.1. Abbildungsverzeichnis 21 8.2. Votum der Ethikkommission 22 8.3. Selbstständigkeitserklärung 23 8.4. Lebenslauf 24 8.5. Danksagung 25

The presented thesis summarizes the results of research on craniofacial morphology in patients with facial cleft defects in relation to therapeutic approaches (Caganova et al., 2014; Dadáková et al., 2016; Hoffmannova et al., 2016; Hoffmannova et al., 2018; Moslerová et al., 2018). The effect of therapy in individuals with pathological growth disorders cannot be evaluated without detailed auxological studies of control subjects whose facial morphology, longitudinal changes, or manifestations of sexual dimorphism were evaluated upon similar methodology (Koudelová et al. 2015). Therefore, the thesis was conceived as a volume of six publications complemented with a general synthetic introduction into the area of study. Together, the thesis includes probands in a broad age spectrum from birth to 15 years with a total of 294 facial 3D scans, 36 tele-X-ray face images, 3D scans of 112 gypsum palate castings. The methods of geometric morphometry and multidimensional statistics prevail in the assessment. The main clinical part of the thesis deals with the influence of two types of surgery on the facial growth and development of patients with cleft palate, namely secondary spongioplasty (SS) and neonatal cheiloplasty (NCH). Neonatal cheiloplasty (NCH) is the surgery whose effects were studied from several...