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Abirami S, Panchanadikar N, Muthu MS, Balasubramanian S, Murthy J, Mohan A, Haridoss S, Subbalekshmi T. Effect of Sustained Interventions from Infancy to Toddlerhood in Children with Cleft Lip and Palate for Preventing Early Childhood Caries. Caries Res 2021; 55:554-562. [PMID: 34293739 DOI: 10.1159/000517210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
The study aimed to evaluate the effectiveness of sustained interventions in children with cleft lip and palate (CLP) for preventing early childhood caries (ECC). This prospective, nonrandomized interventional cohort study was conducted in infants aged 0-12 months with congenital CLP. Interventions were given to parents/primary caregivers in the form of combined oral health-care measures (sterile wet gauze piece, finger brush, toothbrush, and toothpaste) by a motivational interviewing approach. Education of primary caregivers on oral hygiene was provided by audiovisual aids and demonstration. Reinforcement of the prescribed regimen was done through daily short message services in caregivers' preferred language and bimonthly telephone calls. Participants were followed up for 9-32 months from the time of recruitment, with a mean period of 18.3 ± 5.1 months. Rates of dental caries were represented as prevalence rates, incidence density, and transitional probability. The distribution of the International Caries Detection and Assessment System (ICDAS) scores on different tooth surfaces affected in the intervention group was compared descriptively with that of the age- and sex-matched historical control groups. On analysis of surface-wise distribution of the ICDAS scores in the intervention group (n = 1,919), 1.2% (n = 24) had noncavitated lesions (ICDAS codes 1 and 2), 0.88% (n = 17) had cavitated lesions (ICDAS codes 3-6), and 0.26% (n = 5) had both cavitated and noncavitated lesions (ICDAS codes 1-6). The incidence density of caries-affected children observed at the first and last follow-ups was 1.2 persons/100 person-months and 1.3 persons/100 person-months of observation, respectively. The incidence density of new caries-affected tooth surfaces at the first and last follow-ups was 0.163 surfaces/100 surface-months and 0.062 surfaces/100 surface-months, respectively. Maxillary first molars had the maximum transition from sound to the cavitated lesion (11.5%), followed by maxillary incisors from sound to noncavitated (7.5%) at the last follow-up. Based on the newly developed assessment criteria in our study, sustained interventions proved to be significantly effective in preventing ECC in children with CLP.
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Affiliation(s)
- Sivasubramanian Abirami
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Noopur Panchanadikar
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Murugan Satta Muthu
- Department of Pediatric and Preventive Dentistry, Head, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, India.,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | | | - Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Anusha Mohan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Selvakumar Haridoss
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Munger RG, Kuppuswamy R, Murthy J, Balakrishnan K, Thangavel G, Sambandam S, Kurpad AV, Molloy AM, Ueland PM, Mossey PA. Maternal Vitamin B 12 Status and Risk of Cleft Lip and Cleft Palate Birth Defects in Tamil Nadu State, India. Cleft Palate Craniofac J 2021; 58:567-576. [PMID: 33686867 DOI: 10.1177/1055665621998394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The causal role of maternal nutrition in orofacial clefts is uncertain. We tested hypotheses that low maternal vitamin B12 and low folate status are each associated with an increased risk of isolated cleft lip with or without cleft palate (CL±P) in a case-control study in Tamil Nadu state, India. METHODS Case-mothers of CL±P children (n = 47) and control-mothers of unaffected children (n = 50) were recruited an average of 1.4 years after birth of the index child and plasma vitamin B12, methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured at that time. Logistic regression analyses estimated associations between nutrient biomarkers and case-control status. RESULTS Odds ratios (ORs) contrasting biomarker levels showed associations between case-mothers and low versus high plasma vitamin B12 (OR = 2.48, 95% CI, 1.02-6.01) and high versus low plasma MMA, an indicator of poor B12 status (OR = 3.65 95% CI, 1.21-11.05). Case-control status was not consistently associated with folate or tHcy levels. Low vitamin B12 status, when defined by a combination of both plasma vitamin B12 and MMA levels, had an even stronger association with case-mothers (OR = 6.54, 95% CI, 1.33-32.09). CONCLUSIONS Mothers of CL±P children in southern India were 6.5 times more likely to have poor vitamin B12 status, defined by multiple biomarkers, compared to control-mothers. Further studies in populations with diverse nutritional backgrounds are required to determine whether poor maternal vitamin B12 or folate levels or their interactions are causally related to CL±P.
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Affiliation(s)
- Ronald G Munger
- Department of Nutrition, Dietetics, and Food Sciences, 4606Utah State University, Logan, Utah, the United States
| | - Rajarajeswari Kuppuswamy
- Department of Environmental Health Engineering, 29875Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Jyotsna Murthy
- Department of Plastic and Reconstructive Surgery, 29875Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, 29875Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, 29875Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Sankar Sambandam
- Department of Environmental Health Engineering, 29875Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Anura V Kurpad
- Division of Nutrition, 246827St. John's Research Institute, Bangalore, India
| | - Anne M Molloy
- Biomedical Sciences Institute, 214057Trinity College, Dublin, Ireland
| | - Per M Ueland
- Department of Clinical Science, 1658University of Bergen, Bergen, Norway
| | - Peter A Mossey
- School Dentistry, 3042University of Dundee, Dundee, Scotland, UK
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Abstract
Burden of care has become a commonly used terminology in healthcare in the recent years. Burden of care is the balance how much patients and families commit to their time, compromise quality of life, undergo multiple interventions, and take risks weighing against the benefits the patients and families receive. Cleft lip and palate, congenital anomaly, demands a long-term and interdisciplinary care. These children are at high risk of various treatment/intervention episodes increasing the burden of care. This subject has been widely discussed with many other diseases and health conditions at national, international meetings, and World Health Organization as well. We bring out some facts and practices affecting the burden of care in cleft lip and palate.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
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Murthy J. Commentary on: Management of cleft lip and palate in Egypt - A national survey. Indian J Plast Surg 2019; 51:296-297. [PMID: 30983729 PMCID: PMC6440353 DOI: 10.4103/ijps.ijps_246_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Abstract
Aim: Repair of cleft lip aims to bring symmetry and provide normal aesthetics for the lip. Several techniques have been employed; however, the finer aspect of median lip tubercle has not been emphasised in cleft lip repair. Materials and Methods: We have modified cleft lip repair, both unilateral and bilateral, preserving all the tissues of the median tubercle to provide normal-looking median tubercle of the lip. The modified technique was carried out by a single surgeon on 322 cases of unilateral cleft lip and 68 cases of bilateral cleft lip. Follow-up was done for 1–3 years on these children to evaluate the outcome. Results: The evaluation showed excellent results in more than 80% of patients in unilateral cleft lip repair, on 1–3 years of follow-up; 20% had acceptable results. Of 68 patients with bilateral cleft lip, none had any complication, and excellent results were obtained in 70%. Result was rated acceptable in 30%; 15% may need revision surgery for white roll and vermilion adjustment. Conclusion: We present the technique of reconstructing a normal-looking median tubercle in cleft lip repair. The technique was modified based on the study of normal upper lip and embryology of cleft lip, with emphasis on creating better median tubercle of the lip.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Murthy J, Mokal NJ. Dr Samuel Noordhoff (1927–2018). Indian J Plast Surg 2018. [PMCID: PMC6440343 DOI: 10.4103/ijps.ijps_267_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Nitin J. Mokal
- Department of Plastic Surgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Gurramkonda VB, Syed AH, Murthy J, Lakkakula BV. IRF6 rs2235375 single nucleotide polymorphism is associated with isolated non-syndromic cleft palate but not with cleft lip with or without palate in South Indian population. Braz J Otorhinolaryngol 2018; 84:473-477. [PMID: 28712851 PMCID: PMC9449191 DOI: 10.1016/j.bjorl.2017.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/16/2017] [Accepted: 05/28/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction Transcription factors are very diverse family of proteins involved in activating or repressing the transcription of a gene at a given time. Several studies using animal models demonstrated the role of transcription factor genes in craniofacial development. Objective We aimed to investigate the association of IRF6 intron-6 polymorphism in the non-syndromic cleft lip with or without palate in a South Indian population. Methods 173 unrelated nonsyndromic cleft lip with or without cleft palate patients and 176 controls without clefts patients were genotyped for IRF6 rs2235375 variant by allele-specific amplification using the KASPar single nucleotide polymorphism genotyping system. The association between interferon regulatory factor-6 gene intron-6 dbSNP208032210:g.G>C (rs2235375) single nucleotide polymorphism and non-syndromic cleft lip with or without palate risk was investigated by chi-square test. Results There were significant differences in genotype or allele frequencies of rs2235375 single nucleotide polymorphism between controls and cases with non-syndromic cleft lip with or without palate. IRF6 rs2235375 variant was significantly associated with increased risk of non-syndromic cleft lip with or without palate in co-dominant, dominant (OR: 1.19; 95% CI 1.03–2.51; p = 0.034) and allelic models (OR: 1.40; 95% CI 1.04–1.90; p = 0.028). When subset analysis was applied significantly increased risk was observed in cleft palate only group (OR dominant: 4.33; 95% CI 1.44–12.97; p = 0.005). Conclusion These results suggest that IRF6 rs2235375 SNP play a major role in the pathogenesis and risk of developing non-syndromic cleft lip with or without palate.
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Abstract
Objective We report an unusual association of complete cleft of the primary and secondary palate with Seckel syndrome. Seckel syndrome is a very rare syndrome, with only 60 reported cases in the medical literature. It is an autosomal recessive disorder characterized by birdlike face, intrauterine growth retardation, dwarfism, and microcephaly. This young child of 5 years had a successful cleft lip repair under general anesthesia. The main features of the syndrome and the technical problems of anesthesia and surgery are discussed.
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Affiliation(s)
- Jyotsna Murthy
- Sri Ramachandra Medical College and Research Institute (DU), Chennai, India.
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Raju GT, Lakkakula BVKS, Murthy J, Kannan MA, Paul SFD. Transmission analysis of TGFB1 gene polymorphisms in non-syndromic cleft lip with or without cleft palate. Int J Pediatr Otorhinolaryngol 2017; 100:14-17. [PMID: 28802359 DOI: 10.1016/j.ijporl.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/10/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Transforming growth factor beta1 (TGF-β1) plays a significant role in craniofacial development. Previous linkage studies reported that the TGF-β1-locus at 19q13.1 harbour predisposing genes for non-syndromic oral clefts. In the present study case parents triads were evaluated to find the transmission effects of genetic variants in TGF- β1 towards non-syndromic cleft lip or palate (NSCL/P). METHODS Using allelic discrimination method148 families (case-parent triads) were assessed for single nucleotide polymorphisms (SNPs) in TGF-β1 gene. The SNPs were checked for mendelian errors and Hardy-Weinberg equilibrium (HWE). Transmission disequilibrium test and haplotype frequencies were estimated. RESULTS The TGF-β1 SNPs showed very low minor allele frequencies (MAFs) and observed heterozygosity (Hobs). The transmission disequilibrium test (TDT) and parent-of-origin likelihood ratio tests (PO-LRT) were not significant for any of the SNPs tested. Strong linkage disequilibrium (r2 = 0.722) was found between rs1800469 and rs1800470 SNPs. Haplotype analysis ignoring parent of origin showed strong evidence of excess transmission but it is not significant (p-value = 0.293). CONCLUSION Transmission of minor alleles were not observed from either parent indicating that the TGF-β1 gene polymorphisms by themselves do not confer risk for non-syndromic oral clefts but, rather, modify the stability and the activation process of TGF-β1. As the number of families included in the study are less, results must be considered still preliminary and require replication using more families.
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Affiliation(s)
- Ginila T Raju
- Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India
| | - Bhaskar V K S Lakkakula
- Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India; Sickle Cell Institute Chhattisgarh, Raipur, India
| | - Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | | | - Solomon F D Paul
- Department of Human Genetics, Sri Ramachandra University, Chennai, India.
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Murthy J. From president's desk: Special issue for cleft congress 2017. J Cleft Lip Palate Craniofac Anomal 2017. [DOI: 10.4103/jclpca.jclpca_90_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Breugem CC, Evans KN, Poets CF, Suri S, Picard A, Filip C, Paes EC, Mehendale FV, Saal HM, Basart H, Murthy J, Joosten KFM, Speleman L, Collares MVM, van den Boogaard MJH, Muradin M, Andersson MEM, Kogo M, Farlie PG, Don Griot P, Mossey PA, Slator R, Abadie V, Hong P. Best Practices for the Diagnosis and Evaluation of Infants With Robin Sequence: A Clinical Consensus Report. JAMA Pediatr 2016; 170:894-902. [PMID: 27429161 DOI: 10.1001/jamapediatrics.2016.0796] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and upper airway obstruction. Currently, no consensus exists regarding the diagnosis and evaluation of children with RS. An international, multidisciplinary consensus group was formed to begin to overcome this limitation. OBJECTIVE To report a consensus-derived set of best practices for the diagnosis and evaluation of infants with RS as a starting point for defining standards and management. EVIDENCE REVIEW Based on a literature review and expert opinion, a clinical consensus report was generated. FINDINGS Because RS can occur as an isolated condition or as part of a syndrome or multiple-anomaly disorder, the diagnostic process for each newborn may differ. Micrognathia is hypothesized as the initiating event, but the diagnosis of micrognathia is subjective. Glossoptosis and upper airway compromise complete the primary characteristics of RS. It can be difficult to judge the severity of tongue base airway obstruction, and the possibility of multilevel obstruction exists. The initial assessment of the clinical features and severity of respiratory distress is important and has practical implications. Signs of upper airway obstruction can be intermittent and are more likely to be present when the infant is asleep. Therefore, sleep studies are recommended. Feeding problems are common and may be exacerbated by the presence of a cleft palate. The clinical features and their severity can vary widely and ultimately dictate the required investigations and treatments. CONCLUSIONS AND RELEVANCE Agreed-on recommendations for the initial evaluation of RS and clinical descriptors are provided in this consensus report. Researchers and clinicians will ideally use uniform definitions and comparable assessments. Prospective studies and the standard application of validated assessments are needed to build an evidence base guiding standards of care for infants and children with RS.
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Affiliation(s)
- Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kelly N Evans
- Seattle Children's Craniofacial Center, Department of Pediatrics, University of Washington, Seattle
| | | | - Sunjay Suri
- Faculty of Dentistry, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arnaud Picard
- Division of Plastic and Maxillofacial Surgery, Necker Children's Hospital, Paris, France
| | - Charles Filip
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Felicity V Mehendale
- Cleft Lip and Palate Service, University of Edinburgh, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Howard M Saal
- Division of Human Genetics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hanneke Basart
- Division of Plastic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Jyotsna Murthy
- Cleft and Craniofacial Center, Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - Koen F M Joosten
- Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lucienne Speleman
- Division of Ear, Nose and Throat Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marcus V M Collares
- Department of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul Federal University, Porto Alegre, Brazil
| | - Marie-José H van den Boogaard
- Department of Clinical Genetics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marvick Muradin
- Department of Maxillofacial Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Maud Els-Marie Andersson
- Department of Orthodontics, Dental Faculty, University of Oslo, Oslo, Norway17Oslo Cleft Team, Department of Plastic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mikihiko Kogo
- Division of Maxillofacial Surgery, Osaka University Cleft Palate Center, Osaka, Japan
| | - Peter G Farlie
- Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Australia
| | - Peter Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | | | - Rona Slator
- West Midlands Cleft Service, Birmingham Children's Hospital, Birmingham, England
| | - Veronique Abadie
- Department of General Pediatrics, National Referral Center for Pierre Robin Sequence, Necker Hospital, Paris Descartes University, Paris, France
| | - Paul Hong
- Division of Otolaryngology, Department of Surgery, Izaak Walton Killam Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
INTRODUCTION Pre-maxillary complex (pre-maxilla [PMX] + vomer) morphology in bilateral complete cleft of primary and secondary palate (BCLCP) is very complex and less reviewed in literature. MATERIALS AND METHODS In this retrospective cross-sectional study, 200 consecutive BCLCP patients were selected. Their pre-operative clinical photographs and dental casts were evaluated by a single investigator at two different points of time, to study the morphology of PMX and vomer with special emphasis on deviation of vomer and rotation of PMX. RESULTS It is found that in above 70% of patients, PMX and vomer both displaced or deviated towards left side in horizontal plane and PMX rotated anticlockwise at PMX vomerine suture (PVS). In 10% of cases, both PMX and vomer are displaced towards the right side, PMX rotated clockwise at PVS. In 11% of cases, vomer is displaced towards the left side, but PMX rotated clockwise at PVS. In 5% of cases, vomer is displaced towards the right side, but PMX rotated anticlockwise at PVS. Both PMX and vomer are in midline in 4% of cases. CONCLUSION Specific morphological deviation of vomer and PMX has been studied. We put forward the probable hypothesis to explain the deviation and rotation of PMX.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Srugery, Sri Ramachandra University, Chennai, India
| | - Devi Manisha
- Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
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Babu Gurramkonda V, Syed AH, Murthy J, V K S Lakkakula B. Association of TFAP2A gene polymorphism with susceptibility to non-syndromic cleft lip with or without palate risk in south Indian population. Meta Gene 2016; 9:181-4. [PMID: 27617216 PMCID: PMC5006125 DOI: 10.1016/j.mgene.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022] Open
Abstract
The aetiology of non-syndromic cleft lip with or without cleft palate (NSCL/P) is complex involving multiple interacting genes and environmental factors. The primary objective of the present study was to investigate the role of TFAP2A gene single nucleotide polymorphisms (SNPs) in the pathogenesis of NSCL/P. In this study, 173 unrelated NSCL/P patients and 176 controls without clefts were genotyped with TFAP2A rs1675414 (Exon 1), rs3798691 (Intron 1), and rs303050 (Intron 4) variants by allele-specific amplification using the KASPar SNP genotyping system. The method of multifactor dimensionality reduction (MDR) was used to analyze gene-gene interactions. TFAP2A polymorphisms are not found to be associated with non-syndromic cleft lip with or without cleft palate (NSCL/P) at either the genotype or allele levels. No linkage disequilibrium (LD) was found between TFAP2A variants. MDR analysis did not show a significant effect of the TFAP2A gene polymorphisms on susceptibility to NSCL/P (p > 0.05). These results suggest that the analyzed variations in TFAP2A gene might not be associated with NSCL/P pathogenesis in south Indian population.
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Affiliation(s)
| | - Altaf Hussain Syed
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - Bhaskar V K S Lakkakula
- Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India; Sickle Cell Institute Chhattisgarh, Raipur, India
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Babu Gurramkonda V, Hussain Syed A, Murthy J, Chaubey G, Bhaskar Lakkakula VKS. Polymorphic variants near 1p22 and 20q11.2 loci and the risk of non-syndromic cleft lip and palate in South Indian population. Int J Pediatr Otorhinolaryngol 2015; 79:2389-93. [PMID: 26586245 DOI: 10.1016/j.ijporl.2015.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent genome-wide association studies (GWAS) have reported multiple genetic risk loci for non-syndromic orofacial clefts (NSOFCs) in many populations. However, the contribution of these loci to NSOFC in India, which comprises one-fifth of the global population, is completely lacking. Our aim was to replicate the association of the SNPs located on 1p22 chromosomal loci (rs540026, rs481931) and 20q11.2 (rs13041247, rs11696257) in the aetiology of NSOFCs, in South Indian populations. METHODS The SNPs were genotyped by using KBiosciences KASPar SNP genotyping chemistry in 173 cases and 176 controls for NSOFCs in South India. To estimate the association between these SNPs and NSOFCs, chi-square test was adopted. Odds ratios (OR) with 95% confidence intervals (CI) were also calculated in order to assess the risk. RESULTS Single nucleotide polymorphisms located at chromosomal region 1p22 are not found to be associated with cleft lip with or without non-syndromic cleft palate (NSCL/P) and non-syndromic cleft palate only (NSCPO) at either the genotype or allele levels. Further, there is no LD observed between these variants. The polymorphic variants near 20q11.2 (rs13041247, rs11696257) are in complete linkage disequilibrium (LD) and are significantly associated with only NSCL/P in genotypic (p=0.013) and allelic models (p=0.029). In the genotypic model significance persisted even after Bonferroni correction (p<0.016). CONCLUSION These results suggest that 20q11.2 SNPs could play a contributory role in the pathophysiology and risk of NSCL/P, while the variations in 1p22 do not underlie the pathophysiology of NSOFCs in South Indian populations.
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Affiliation(s)
| | - Altaf Hussain Syed
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Murthy J, Venkatesh Babu G, Bhaskar LVKS. TYMS gene 5'- and 3'-untranslated region polymorphisms and risk of non-syndromic cleft lip and palate in an Indian population. J Biomed Res 2015; 29:337-9. [PMID: 26243522 PMCID: PMC4547384 DOI: 10.7555/jbr.29.20140140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/25/2015] [Accepted: 02/12/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - G Venkatesh Babu
- Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India
| | - L V K S Bhaskar
- Department of Biomedical Sciences, Sri Ramachandra University, Chennai, India.
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Ravi BK, Padmasani LN, Hemamalini AJ, Murthy J. Weight Gain Pattern of Infants with Orofacial Cleft on Three Types of Feeding Techniques. Indian J Pediatr 2015; 82:581-5. [PMID: 25650232 DOI: 10.1007/s12098-014-1668-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the efficacy of the three feeding techniques commonly used in authors' setup in improving the weight gain pattern of children with orofacial cleft. METHODS A cohort prospective study was employed. A total sample of 150 infants at the age of 2 mo with cleft of both lip and palate were recruited and followed bimonthly until their first birthday to assess the pattern of weight gain. The subjects were categorized into three groups based on their habitual feeding techniques such as Group I: Paladai fed; Group II: Bottle fed and Group III: Spoon fed with 50 subjects in each group. The three groups were counseled on nutritional aspects, correct infant positioning and hygienic practices. RESULTS The mean weight of the Group I subjects was observed to be higher than the other two groups at every visit and was also found to be statistically significant at p < 0.001. Over all comparison proved that the weight gain of 1.364 ± 0.191, 1.348 ± 0.284 and 1.450 ± 0.205 and the velocity of weight gain, kg per week of 0.17 ± 0.023, 0.168 ± 0.035 and 0.181 ± 0.025 of Group I at 4, 6 and 8th mo respectively were significantly higher than the other two groups (p < 0.001). CONCLUSIONS Of the three feeding techniques adopted by the mothers of infants with orofacial cleft, it was noted that paladai feeding was better than the bottle or spoon-feeding.
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Affiliation(s)
- B Kundhala Ravi
- Department of Clinical Nutrition, Sri Ramachandra University, Chennai, 600116, India,
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Koteswara Prasad NK, Hussain SA, Chitharanjan AB, Murthy J. Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient. Indian J Plast Surg 2015; 48:89-91. [PMID: 25991895 PMCID: PMC4413499 DOI: 10.4103/0970-0358.155278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction.
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Affiliation(s)
- N K Koteswara Prasad
- Department of Orthodontics, Faculty of Dental Sciences, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
| | - Syed Altaf Hussain
- Cleft and Craniofacial Center, Department of Plastic Surgery, Faculty of Medicine, Sri Ramachandra University, Chennai, India
| | - Arun B Chitharanjan
- Department of Orthodontics, Faculty of Dental Sciences, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
| | - Jyotsna Murthy
- Cleft and Craniofacial Center, Department of Plastic Surgery, Faculty of Medicine, Sri Ramachandra University, Chennai, India
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Ganesh P, Murthy J, Ulaghanathan N, Savitha VH. A randomized controlled trial comparing two techniques for unilateral cleft lip and palate: Growth and speech outcomes during mixed dentition. J Craniomaxillofac Surg 2015; 43:790-5. [PMID: 25958096 DOI: 10.1016/j.jcms.2015.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/19/2015] [Accepted: 03/26/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. MATERIAL AND METHODS A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7-10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. RESULTS A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. CONCLUSIONS Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.
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Affiliation(s)
- Praveen Ganesh
- Department of Cranio-Maxillofacial Surgery, Mazumdar Shaw Medical Center, Narayana Health City, Bommasandra, Bangalore, Karnataka, 560099, India.
| | - Jyotsna Murthy
- Department of Plastic and Reconstructive Surgery, Sri Ramachandra University, Chennai, India
| | - Navitha Ulaghanathan
- Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, Chennai, India
| | - V H Savitha
- Department of Speech, Language & Hearing Sciences, Sri Ramachandra University, Chennai, India
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Kumar MS, Kumar NR, Murthy J, Sharma M, Thamilselvan P. Psychosocial issues of parents of children with cleft lip and palate in relation to their behavioral problems. J Cleft Lip Palate Craniofac Anomal 2015. [DOI: 10.4103/2348-2125.150749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Murthy J, Gurramkonda VB, Lakkakula BVKS. Significant association of MTHFD1 1958G>A single nucleotide polymorphism with nonsyndromic cleft lip and palate in Indian population. Med Oral Patol Oral Cir Bucal 2014; 19:e616-21. [PMID: 25129243 PMCID: PMC4259380 DOI: 10.4317/medoral.19796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/10/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives: Nonsyndromic cleft lip and palate (NSCLP) is genetically distinct from those with syndromic clefts, and accounts for ~70% of cases with Oral clefts. Folate, or vitamin B9, is an essential nutrient in our diet. Allelic variants in genes involved in the folate pathway might be expected to have an impact on risk of oral clefts. Given the key role of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) in folate metabolism, it would be of significant interest to assess its role in NSCLP etiology.
Study Design: The present study aims at examining the association between MTHFD1 1958G>A polymorphism and NSCLP risk by conducting a case-control study in south Indian population. Our sample comprised of 142 cases with nonsyndromic clefts and 141 controls without clefts or family history of clefting. The MTHFD1 1958G>A polymorphism was genotyped using PCR-RFLP.
Results: An increased risk was found for the heterozygous 1958GA (OR=2.44; P=0.020) and homozygous 1958AA (OR=2.45; P=0.012) genotypes in the children. When the dominant model (AG+AA vs GG) was applied the risk remained the same as co-dominant model, but the level of significance increased (OR=2.44; P=0.002).
Conclusions: The results indicated the MTHFD1 1958G>A polymorphism to be one of the important genetic determinants of NSCLP risk in South Indian subjects.
Key words:MTHFD1, orofacial cleft, SNP, genetics.
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Affiliation(s)
- Jyotsna Murthy
- Department of Biomedical Sciences, Sri Ramachandra University, No.1 Ramachandra Nagar, Porur, Chennai - 600 116,
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Lakkakula B, Murthy J, Gurramkonda VB. Relationship between reduced folate carrier gene polymorphism and non-syndromic cleft lip and palate in Indian population. J Matern Fetal Neonatal Med 2014; 28:329-32. [PMID: 24749799 DOI: 10.3109/14767058.2014.916677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Folate metabolism involves absorption, transport, modifications and interconversions of folates. The reduced folate carrier does not participate directly in folate metabolism but plays a major role in intracellular transport of metabolically active 5-methyltetrahydrofolate and maintains the intracellular concentrations of folate. The purpose of this study was to identify the prevalence of reduced folate carrier 1 (RFC1) A80G polymorphism and to further delineate its association with non-syndromic cleft lip and palate (NSCLP) in a south Indian population. METHODS In the present case-control study, we studied RFC1 gene A80G polymorphism to evaluate its impact on NSCLP risk in south Indian population. Blood samples of 142 cases with NSCLP and 141 controls were collected and genotyped using PCR-RFLP. RESULTS The genotype distribution in the control group followed Hardy-Weinberg equilibrium (p = 0.633). The G allele frequency of cases was 64.8% (184/284) and was significantly lower than that found in the control group 56.4% (160/282). The genotype distributions between NSCLP cases and controls was not significantly different (p = 0.131). The allelic model significantly increased the risk of NSCLP (G versus A; OR = 1.40; 95% CI: 1.00-1.97; p = 0.050). In subgroup analysis, the A80G variant showed significant association for the CLP group in dominant and allelic models. CONCLUSIONS Altogether, our findings support the hypothesis that RFC1 A80G variant may contribute to NSCLP susceptibility in a south Indian population.
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Murthy J, Lakkakula S, Gurramkonda VB, Pathapati RM, Maram R, Lakkakula BVKS. CBS c.844ins68 Polymorphism Frequencies in Control Populations: Implications on Nonsyndromic Cleft Lip With or Without Cleft Palate. Cleft Palate Craniofac J 2014; 52:49-53. [PMID: 24437588 DOI: 10.1597/13-051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nonsyndromic cleft lip with or without cleft palate (NSCLP) is a common birth defect with substantial clinical and social impact. Folate deficiency is one of the factors that have been associated with increased risk for NSCLP. Polymorphisms in folate and homocysteine pathway genes may act as susceptibility factors. OBJECTIVE The objective of this study was to evaluate prevalence estimates of cystathionine beta-synthase (CBS) insertion of 68-bp (c.844ins68) polymorphisms and their correlation with NSCLP. MATERIAL AND METHODS A total of 236 unrelated individuals from seven Indian populations and an additional 355 cases with NSCLP and 357 controls without NSCLP were included in this study. We investigated the CBS c.844ins68 polymorphism in all samples. Genotyping was performed with polymerase chain reaction and electrophoresis. The data were statistically analyzed using the chi-square test. RESULTS The CBS c.844ins68 allele is present in six of the seven populations analyzed, and allele frequencies range from 1.5% in Balija to 9.1% in Sugali populations. The CBS c.844ins68 polymorphism showed a significant protective effect on NSCLP at both genotype (WW versus WI: odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.31 to 0.95, P = .149) and allele levels (W versus I: OR = 0.56, 95% CI = 0.32 to 0.96, P = .033). CONCLUSIONS The current study observed significant differences in the frequency of the CBS 844ins68 allele across populations. There is a significant association between CBS c.844ins68 polymorphism and cleft lip and palate in the Indian population. Additional studies are warranted to identify the functional variants in the genes controlling homocysteine as etiological contributors to the formation of oral clefts.
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Gurramkonda VB, Murthy J, Syed AH, Lakkakula BVKS. Lack of association between IRF6 polymorphisms and nonsyndromic oral clefts in South Indian population. d3000 2013. [DOI: 10.5195/d3000.2013.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This present study is aimed to investigate the association between interferon regulatory factor 6 (IRF6), single nucleotide polymorphisms (SNPs), and nonsyndromic cleft lip without without cleft palate (NSCLP) in the South Indian population. Subject and Methods: For this study, 190 unrelated NSCLP patients and 189 controls without clefts were genotyped with rs2235371 (V2741) and rs642961 SNPs using PCR-RFLP. The associations between NSCLP groups and IRF6 gene polymorphisms, as well as haplotypes, were analyzed using chi-squared test and 95% confidence interval (95%CI) of the odds ratios were calculated with the control groups as reference. Results: For controls, the minor allele frequencies of both variants, V2741 and rs642961, were 7.1% and 21.1%, respectively. Genotype data for both variants in control and cleft groups follow the Hardy Weinberg Equilibrium. Between cases with NSCLP and controls, the two SNPs showed no differences in frequencies of the genotypes or alleles. The pairwise linkage disequilibrium (LD) values (D’=1 and r2=0.027) between V2741 and rs642961 revealed that these two SNPs are not in strong LD. Haplotype G-T showed a significantly reduced risk for oral clefts (p<0.001) and haplotype A-T increased the risk for oral clefts (p=0.043). Gene-gene interaction showed that the higher risk group contains more GG-CC combination of cases that the controls, but this model was not significantly associated with cleft status (p=0.136) Conclusion: In conclusion, while IRF6 is strongly associated in other populations, this study demonstrated that variants in IRF6 may play a role in NSCLP in a South Indian population, but other genes are expected to play a role in this population as well.
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Murthy J, Joshi R, Neal B, Seshadri V, Rama Raju K, Krishnam Raju P. Mortality in People with Epilepsy: A Prospective Study in a Prevalent Epilepsy Cohort in South India (P07.117). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Murthy J. Naso-maxillary complex in size, position and orientation in surgically treated and untreated individuals with cleft lip and palate. Indian J Plast Surg 2012. [DOI: 10.4103/0970-0358.96591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Chief Coordinator, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
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Murthy J. Naso-maxillary complex in size, position and orientation in surgically treated and untreated individuals with cleft lip and palate. Indian J Plast Surg 2012; 45:75-6. [PMID: 22754158 PMCID: PMC3385405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Chief Coordinator, Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India. E-mail:
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Mossey PA, Shaw WC, Munger RG, Murray JC, Murthy J, Little J. Global oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions. Adv Dent Res 2011; 23:247-58. [PMID: 21490237 DOI: 10.1177/0022034511402083] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The birth prevalence of orofacial clefts, one of the most common congenital anomalies, is approximately one in 700 live births, but varies with geography, ethnicity, and socio-economic status. There is a variation in infant mortality and access to care both between and within countries, so some clefts remain unrepaired into adulthood. Quality of care also varies, and even among repaired clefts there is residual deformity and morbidity that significantly affects some children. The two major issues in attempts to address these inequalities are (a) etiology/possibilities for prevention and (b) management and quality of care. For prevention, collaborative research efforts are required in developing countries, in line with the WHO approach to implement the recommendations of the 2008 Millennium Development Goals (www.un.org/millenniumgoals). This includes the "common risk factor" approach, which analyzes biological and social determinants of health alongside other chronic health problems such as diabetes and obesity, as outlined in the Marmot Health inequalities review (2008) (www.ucl.ac.uk/gheg/marmotreview). Simultaneously, orofacial cleft research should involve clinical researchers to identify inequalities in access to treatment and identify the best interventions for minimizing mortality and residual deformity. The future research agenda also requires engagement with implementation science to get research findings into practice.
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Affiliation(s)
- P A Mossey
- University of Dundee Dental Hospital & School, Scotland, UK.
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Bhaskar L, Murthy J, Venkatesh Babu G. Polymorphisms in genes involved in folate metabolism and orofacial clefts. Arch Oral Biol 2011; 56:723-37. [DOI: 10.1016/j.archoralbio.2011.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 11/24/2022]
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Abstract
Introduction: With advancement of medical services in developed countries and awareness among the patients, it is rare to find an adult with an unoperated cleft lip and palate. However, the scenario is totally different in developing countries. Working as a part of a team in developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal, the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic multidisciplinary care, the priority is getting treatment for all cleft patients. In such situation, the management of cleft lip and palate demands changes of approach, techniques and philosophy. Aims and Objectives: The deformed anatomy especially the facial bones and dentition is described. Due to well established deformities, the approach for management is individualized. The procedures and modification of procedures has been described. Results and Outcome: The outcome of the primary repair is adults certainly have less than satisfactory outcome for obvious reasons. The expected outcome and expectation of patients and families following primary surgeries in cleft lip and palate has been discussed. Though all adult patients got some improvement in speech after palate repair, achieving normal speech was difficult. The naso-labial appearance was not perfect, but well accepted by the patients and families. There are many psychosocial problems in these patients, the objective evaluation could not be done due to too many variables. However, primary repair of cleft lip and palate is justified and beneficial for the patients.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Chief Coordinator, Cleft & Craniofacial Centre, Sri Ramachandra University, Chennai, India
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Abstract
Nonsyndromic cleft lip and palate is a complex genetic disorder with variable phenotype, largely attributed to the interactions of the environment and multiple genes, each potentially having certain effects. Numerous genes have been reported in studies demonstrating associations and/or linkage of the cleft lip and palate phenotypes to alleles of microsatellite markers and single nucleotide polymorphisms within specific genes that regulate transcription factors, growth factors, cell signalling and detoxification metabolisms. Although the studies reporting these observations are compelling, most of them lack statistical power. This review compiles the evidence that supports linkage and associations to the various genetic loci and candidate genes. Whereas significant progress has been made in the field of cleft lip and palate genetics in the past decade, the role of the genes and genetic variations within the numerous candidate genes that have been found to associate with the expression of the orofacial cleft phenotype remain to be determined.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College, Chennai, India
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Abstract
Objective: Palatal fistula is a significant complication following cleft palate repair. The guidelines of management of the palatal fistula is dependent on the type of cleft, site of fistula, condition of surrounding tissue and associated problem. We studied the management and outcome of 194 cleft palate fistula in our institute. Design: We present the descriptive hospital-based study of management of palatal fistula in 194 cleft patients. We have excluded all the syndromic children and children whose anterior palate was not operated as per protocol. Settings: Of 194 cleft palate fistula, 37 had palate repair in our hospital and 157 were refereed with fistula following palate repair.The patients were evaluated by interdisciplinary team and plan of management was decided. Result: Various parameters like types of cleft, site of fistula and management of fistula were studied in all the patients. Fifty-two percent were in unilateral CLP and 30% in bilateral CLP because unilateral CLP is the commonest type of cleft. Postalveolar and hard palate region contributing to 67% of all fistulae, followed by junctional in (9%). Seventy-two percent of fistula were amenable for repair by local available tissue, 28% needed tongue flap due to shortage of tissue. Minor numbers have failure of procedure for fistula closure needing further management. Conclusions: This descriptive study present analysis of management of fistula in our institute. It also reinforces that patient with bilateral cleft lip and palate more likely to have shortage of local tissue needing the local flaps like tongue flap compare to other cleft types. The surgical management of fistula can be combined to tackle the associated problems.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
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Abstract
Congenital infiltrating lipomatosis of the face is a rare condition characterized by diffuse fatty infiltration of the facial soft tissues. There may be muscle involvement along with associated bony hyperplasia. It is a type of lipomatous tumor that is congenital in origin; it is rare and seen usually in childhood. We recently saw an 11-year-old girl with this condition. She presented with a swelling of the right side of the face that had been present since birth; there were typical findings on plain radiographs, CT, and MRI. The patient underwent cosmetic surgery. Histopathological examination showed mature adipocytes without any capsule.
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Murthy J. Is Bleomycin a worthy alternative? Indian J Plast Surg 2011; 44:54. [PMID: 21713160 PMCID: PMC3111125 DOI: 10.4103/0970-0358.81442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and RI, Chennai, India
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Murthy J. Is Bleomycin a worthy alternative? Indian J Plast Surg 2011. [DOI: 10.1055/s-0039-1699480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and RI, Chennai, India
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Murthy J. Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals. Indian J Plast Surg 2011. [DOI: 10.1055/s-0039-1699477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACT
Objective: Palatal fistula is a significant complication following cleft palate repair. The guidelines of management of the palatal fistula is dependent on the type of cleft, site of fistula, condition of surrounding tissue and associated problem. We studied the management and outcome of 194 cleft palate fistula in our institute. Design: We present the descriptive hospital-based study of management of palatal fistula in 194 cleft patients. We have excluded all the syndromic children and children whose anterior palate was not operated as per protocol. Settings: Of 194 cleft palate fistula, 37 had palate repair in our hospital and 157 were refereed with fistula following palate repair. The patients were evaluated by interdisciplinary team and plan of management was decided. Result: Various parameters like types of cleft, site of fistula and management of fistula were studied in all the patients. Fifty-two percent were in unilateral CLP and 30% in bilateral CLP because unilateral CLP is the commonest type of cleft. Postalveolar and hard palate region contributing to 67% of all fistulae, followed by junctional in (9%). Seventy-two percent of fistula were amenable for repair by local available tissue, 28% needed tongue flap due to shortage of tissue. Minor numbers have failure of procedure for fistula closure needing further management. Conclusions: This descriptive study present analysis of management of fistula in our institute. It also reinforces that patient with bilateral cleft lip and palate more likely to have shortage of local tissue needing the local flaps like tongue flap compare to other cleft types. The surgical management of fistula can be combined to tackle the associated problems.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
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Yalavarthy A, Rajeswaran R, Chandrasekhar A, Murthy J. An unusual presentation of lipofibromatous hamartoma in an infant. A case report. Neuroradiol J 2010; 23:447-51. [PMID: 24148637 DOI: 10.1177/197140091002300414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 06/27/2010] [Indexed: 11/16/2022] Open
Abstract
Lipofibromatous hamartomas are rare benign tumors presenting in the third and fourth decades with a predilection for the upper extremity. We describe an unusual presentation of lipofibromatous hamartoma occurring in a one month old female child, where the lesion showed MR findings resembling that of a vascular malformation.
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Affiliation(s)
- A Yalavarthy
- Department of Radiology and Imaging Sciences, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University; Chennai, India -
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Abstract
Objective Early palate repair is recommended to minimize the development of disordered speech. We studied the speech outcome of late palate repair in 131 patients. The success of late palate repair is questioned because of the persistence of learned, compensatory misarticulations that are difficult to correct in spite of the establishment of correct palatal anatomy and a competent velopharyngeal mechanism. The objective of this study is to highlight the speech results following late primary repair of the palate. Settings and Design Retrospective analysis of speech outcomes in 131 patients with cleft lip and palate who underwent primary palate repair after the age of 10 years between November 2000 and December 2004. None of the patients had received supervised institution-based speech therapy. However, all patients were counseled and oriented and demonstrated the correct place and manner of articulation for the phonemes misarticulated by them. Preoperative and 6- to 12-month postoperative speech samples were assessed within the parameters of articulation, hypernasality, nasal air emission, and speech intelligibility. Outcome The analysis indicated improvement in all speech parameters leading to an overall improvement in postoperative intelligibility for most patients. Conclusion Although definite improvement occurs in all parameters of speech following late primary palate repair, residual speech problems persist in most patients, requiring further evaluation and appropriate treatment.
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Affiliation(s)
- Jyotsna Murthy
- Cleft & Craniofacial Center, Professor, Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
| | - Sunitha Sendhilnathan
- Department of Speech, Language, and Hearing Sciences, Sri Ramachandra University, Chennai, India
| | - Syed Altaf Hussain
- Department of Plastic Surgery, Sri Ramachandra University, Chennai, India
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Murthy J. Haemangiomas versus vascular malformations: correct diagnosis for correct treatment. Indian J Surg 2010; 72:79-80. [PMID: 23133215 PMCID: PMC3452550 DOI: 10.1007/s12262-010-0020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/20/2009] [Indexed: 10/19/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu India
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Murthy J. Preface. Indian J Plast Surg 2009; 42 Suppl:S2. [PMID: 19884677 PMCID: PMC2825061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jyotsna Murthy
- Guest Editor, Cleft Supplementary, Indian Journal of Plastic Surgery
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Murthy J. Management of cleft lip and palate in adults. Indian J Plast Surg 2009. [DOI: 10.1055/s-0039-1699384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACT
Introduction: With advancement of medical services in developed countries and awareness among the patients, it is rare to find an adult with an unoperated cleft lip and palate. However, the scenario is totally different in developing countries. Working as a part of a team in developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal, the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic multidisciplinary care, the priority is getting treatment for all cleft patients. In such situation, the management of cleft lip and palate demands changes of approach, techniques and philosophy. Aims and Objectives: The deformed anatomy especially the facial bones and dentition is described. Due to well established deformities, the approach for management is individualized. The procedures and modification of procedures has been described. Results and Outcome: The outcome of the primary repair is adults certainly have less than satisfactory outcome for obvious reasons. The expected outcome and expectation of patients and families following primary surgeries in cleft lip and palate has been discussed. Though all adult patients got some improvement in speech after palate repair, achieving normal speech was difficult. The naso-labial appearance was not perfect, but well accepted by the patients and families. There are many psychosocial problems in these patients, the objective evaluation could not be done due to too many variables. However, primary repair of cleft lip and palate is justified and beneficial for the patients.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Chief Coordinator, Cleft & Craniofacial Centre, Sri Ramachandra University, Chennai, India
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Affiliation(s)
- Jyotsna Murthy
- Guest Editor, Cleft Supplementary, Indian Journal of Plastic Surgery
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Murthy J, Bhaskar LVKS. Current concepts in genetics of nonsyndromic clefts. Indian J Plast Surg 2009. [DOI: 10.1055/s-0039-1699316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACTNonsyndromic cleft lip and palate is a complex genetic disorder with variable phenotype, largely attributed to the interactions of the environment and multiple genes, each potentially having certain effects. Numerous genes have been reported in studies demonstrating associations and/or linkage of the cleft lip and palate phenotypes to alleles of microsatellite markers and single nucleotide polymorphisms within specific genes that regulate transcription factors, growth factors, cell signalling and detoxification metabolisms. Although the studies reporting these observations are compelling, most of them lack statistical power. This review compiles the evidence that supports linkage and associations to the various genetic loci and candidate genes. Whereas significant progress has been made in the field of cleft lip and palate genetics in the past decade, the role of the genes and genetic variations within the numerous candidate genes that have been found to associate with the expression of the orofacial cleft phenotype remain to be determined.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery and Sri Ramachandra Medical College, Chennai, India
| | - L. V. K. S. Bhaskar
- Department of Biomedical Sciences, Sri Ramachandra Medical College, Chennai, India
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Abstract
Roberts SC syndrome is a rare syndrome with only 17 previously recognized patients reported in medical literature. The syndrome is characterized by multiple malformations, particularly, symmetrical limb reduction, craniofacial anomalies such as bilateral cleft lip and palate, micrognathia, and severe growth and mental retardation. Our patient, a young child of five years having Roberts-SC, was successfully operated for cleft palate under general anesthesia. The main features of the syndrome and the technical problems of anesthesia and surgery are discussed in this report.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra University, Porur, Chennai - 600 116, India
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Abstract
The Baller-Gerold syndrome is a rare syndrome with very few cases published in literature. Craniosynostosis and radial aplasia are striking features, easy to diagnose. However, there are many differential diagnoses. Often, the question raised is whether the Baller-Gerald syndrome is a distinct entity. We report a patient with findings of craniosynostosis and radial aplasia consistent with the diagnosis of the Baller-Gerold syndrome. Genotypic heterogeneity could possibly underlie the phenotypic variability exhibited by these cases.
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Murthy J, Babu R, Ramanan PV. Radial, renal and craniofacial anomalies: Baller-Gerold syndrome. Indian J Plast Surg 2008. [DOI: 10.1055/s-0039-1699234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACTthe baller-gerold syndrome is a rare syndrome with very few cases published in literature. craniosynostosis and radial aplasia are striking features, easy to diagnose. however, there are many differential diagnoses. often, the question raised is whether the baller-gerald syndrome is a distinct entity. we report a patient with findings of craniosynostosis and radial aplasia consistent with the diagnosis of the baller-gerold syndrome. genotypic heterogeneity could possibly underlie the phenotypic variability exhibited by these cases.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Director of Cleft and Craniofacial Center
| | | | - padasani Venkat Ramanan
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Rajamani A, Kamat V, Rajavel VP, Murthy J, Hussain SA. A comparison of bilateral infraorbital nerve block with intravenous fentanyl for analgesia following cleft lip repair in children. Paediatr Anaesth 2007; 17:133-9. [PMID: 17238884 DOI: 10.1111/j.1460-9592.2006.02032.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The efficacy of analgesia with bilateral infraorbital nerve block and intravenous (i.v.) fentanyl were compared for cleft lip surgery in children. METHODS Eighty-two children aged 3 months to 10 years undergoing cleft lip repair were prospectively randomized to one of two groups: bilateral infraorbital nerve block (Group B), or i.v. fentanyl (Group F). Group B (n = 41) received bilateral infraorbital injection of 1 ml 0.25% bupivacaine and 2 ml i.v. saline as control. Group F (n = 41) received 2 microg x kg(-1) i.v. fentanyl, and bilateral infraorbital injection of 1 ml saline as control. Pain was evaluated by the incidence of tachycardia, hypertension, and/or modified pain score > or =4. The time to awakening, time to first cry and time to feeding were noted. RESULTS Thirty four children (82.9%) in Group B had adequate analgesia compared with 15 (36.6%) in Group F (P < 0.0001, RR of failure 0.27 for Group B). Group B had a mean time to awakening of 5.65 +/- 2.52 min (Group F: 9.37 +/- 4.50 min; P < 0.0001), time to first cry 32.14 +/- 18.22 min (Group F: 28.00 +/- 16.27 min; P = 0.3), time to feed 62.05 +/- 20.06 min (Group F: 72.44 +/- 17.72; P = 0.015), and pain score 2.81 +/- 1.38 (Group F: 4.71 +/- 1.89; P < 0.0001). There were no major complications. CONCLUSIONS Bilateral infraorbital block is superior to fentanyl in terms of analgesia, and time to awakening and feeding.
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Affiliation(s)
- Arvind Rajamani
- Department of Anaesthesiology and Critical Care, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Nagar, Chennai, India.
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