German animal terms for oral cleft deformity: A Leipzig survey

TCDD induces cleft palate through exosomes derived from mesenchymal cells

TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) is a ubiquitous environmental toxicant and a notable teratogenic agent for cleft palate (CP), a common congenital structural malformation that can result from abnormalities during palatal shelf connection and/or fusion. The development of the palate requires precise coordination between mesenchymal and epithelial cells. Exosomes are vesicles secreted by cells and participate in organ development by transferring various bioactive molecules between cells and regulating cell proliferation, migration, apoptosis, and epithelial-mesenchymal transition (EMT); these vesicles represent a new method of intercellular communication. To explore how TCDD could influence palatal cell behaviors and communication, we treated mesenchymal cells with TCDD, collected the exosomes secreted by the cells, assessed the 2 types of palatal cells, and then observed the effects of TCDD-induced exosomes. We found that the effects of TCDD-induced exosomes were equal to those of TCDD. Thus, TCDD might change the genetic materials of palatal cells and exosomes to cause dysregulated gene expression from parental cells, affect cellular information communicators, and induce abnormal cellular behaviors that could lead to CP.

Bias in a blink: Shedding light on implicit attitudes toward patients with a cleft lip

INTRODUCTION

Previous studies have shown that patients with cleft lip and/or palate may be stigmatized in society. The objective of this study was to use an implicit association test to evaluate the subconscious biases of non-health care providers and orthodontists against patients with a repaired cleft lip (CL).

METHODS

Respondents participated in an implicit association test. Pictures of patients with CL and controls were shown to participants, along with terms representing positive and negative attributes. Participants were prompted to match pictures to the attributes. The software algorithm detected whether the participants were more likely to associate CL with positive or negative terms than controls. Demographic information was collected to measure the association between some sociodemographic factors and implicit biases.

RESULTS

Of 130 valid participants, 52 were orthodontists and 78 were non-health care providers. The entire sample displayed a significant implicit bias against CL (P <0.001). Overall, orthodontists tended to exhibit slightly higher levels of implicit biases against CL than non-health care providers, but the difference was not significant when controlling for sociodemographic factors (P = 0.34). Females showed significantly lower implicit biases against CL than males (P = 0.046). Spearman correlations showed that older people and those who reported a more conservative political affiliation tended to show slightly higher levels of implicit biases against CL (P <0.007).

CONCLUSIONS

Orthodontists and non-health care providers showed moderate but significant levels of implicit biases against patients with clefts. Males, older age groups, and patients with a more conservative political affiliation tended to exhibit slightly higher levels of biases than females, younger people, and those with a more liberal political affiliation.

Comparison of the biological behaviors of palatal mesenchymal and epithelial cells induced by 2,3,7,8-tetrachlorodibenzo-p-dioxin in vitro

2,3,7,8-Tetrachlorodibenzo- p-dioxin (TCDD) effectively induces cleft palate at increased doses, but its mechanism of involvement is unclear, and arguments have examined palatal shelf contact and/or fusion failure. The role of different types of cells constituting palatal skulls remains elusive regarding TCDD dosage. No reports have simultaneously compared the biological behaviors of TCDD- induced mesenchymal and epithelial cells in vitro. This study employed primary epithelial and mesenchymal cells as models in vitro to explore proliferation, migration, apoptosis and epithelial-to-mesenchymal transition with two different doses of TCDD (10 nmol/L, 100 nmol/L), contrasted with a control group without TCDD. Interestingly, we found the EMT process of primary palatal epithelial cells occurred automatically in vitro without helping bilateral palatal contact. The results showed that, with the low dose of TCDD, transformation of epithelial cells to mesenchymal cells was inhibited, and mesenchymal cell proliferation and migration were promoted. At high doses, mesenchymal cells decreased, preventing palate development, uprising and contact, while the EMT of epithelial cells decreased. Regardless of dose of TCDD, no impact on migration and apoptosis of epithelial cells was noted, but there was increased apoptosis of mesenchymal cell in a dose-dependent manner.

Eye tracker based study: Perception of faces with a cleft lip and nose deformity

AIM

Quantification of visual attention directed towards cleft stigmata and its impact on the perception of selected personality traits.

METHODS

Forty observers were divided into two groups and their visual scan paths were recorded. Both groups observed a series of photographs displaying full frontal views of the faces of 18 adult patients with clefts, nine with residual cleft stigmata and nine with digitally-corrected stigmata (each patient only appeared once per series). Patients that appeared with residual stigmata in one series appeared digitally corrected in the other series and vice versa. Visual fixation times on the upper lip and nose were compared between the original and corrected photographs. Observers subsequently rated personality traits as perceived using visual analogue scales and the same photographs that they had observed in the series.

RESULTS

In faces depicting cleft stigmata observers spent more time looking at the oronasal region of interest, followed by the eyes (39.6%; SD 5.0 and 35.1%; SD 3.6, respectively, p = 0.0198). Observers spent more time looking at the cleft lip compared with the corrected lip (21.2%; SD 4.0 and 16.7%; SD 5.0, respectively, p = 0.006). The differences between questionnaire scores for faces with cleft stigmata compared with faces with corrected stigmata for withdrawn-sociable, discontent-content, lazy-assiduous, unimaginative-creative, unlikeable-likeable, and the sum of individual personality traits were not significant.

CONCLUSION

According to these findings, cleft lip and cleft nose have an attention-drawing potential with the cleft lip being the major attention drawing factor. These data do not provide supportive evidence for the notion reported in literature that patients with clefts are perceived as having negative personality traits.

Panel perception of facial appearance of cleft patients generated by use of a morphing technique

OBJECTIVE

Perception of the facial appearance of cleft patients has, until now, been evaluated on the basis of photographs of the patients. Research based on photographs generated by use of a morphing technique has not yet been reported. The purpose of this study was to investigate female and male raters' panel perception with regard to the following: (1) patient age, (2) attractiveness, (3) gender appearance, and (4) likeability of faces of cleft patients generated by the use of a morphing technique.

SETTING

The study was conducted at the Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Germany.

PATIENTS, PARTICIPANTS

We used photographs of 32 adult German nonsyndromic cleft patients, mean age 18.9 ± 1.3 years, and surveyed 93 students, mean age 25.3 ± 3.2 years, by use of a standardized questionnaire.

RESULTS

All respondents rated the mean age of cleft patients equally in unmorphed and morphed pictures. For all respondents, attractiveness of morphed patient pictures was rated significantly higher than for unmorphed pictures (mean 4.8 ± 1.0 vs. 6.4 ± 2.4; p < 0.001), although significance was reached only if morphed pictures of eight patients were rated. Female respondents rated attractiveness significantly higher than did males, especially for pictures of female patients.

CONCLUSION

Facial morphing of patient pictures is a suitable method for creation of standard cleft faces. Despite the modification of the pictures, the faces generated remain human and assessable by panel members. Perception of faces of cleft patients' depended on raters' gender.

Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.