Condylar resorption post mandibular distraction osteogenesis in craniofacial microsomia: A retrospective study

The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.

Respiratory outcome of mandibular distraction osteogenesis on obstructive sleep apnea in craniofacial microsomia: A retrospective study

This study aimed to evaluate the effect of mandibular distraction osteogenesis (MDO) on respiratory function in CFM patients with obstructive sleep apnea (OSA) according to polysomnography (PSG). This study retrospectively analyzed patients with CFM who underwent PSG before surgery and after completion of mandible distraction. Patients who met the inclusion criteria were selected. The Pediatric Sleep Questionnaire (PSQ) was used to assess patients' signs and symptoms related to OSA. The obstructive apnea-hypopnea index (OAHI) and lowest oxygen saturation (LSaO₂) were imported into SPSS version 26.0. The Wilcoxon signed-rank test was used to assess the differences in PSG before and after MDO. Other data were described using descriptive statistics. A P-value less than 0.05 was considered statistically significant. A total of 25 unilateral CFM patients were included in this study. Most patients (72%) had mild OSA; moderate and severe OSA were 12% and 16%, respectively. Snoring (52%) was the most common symptom among these patients. After completion of mandibular distraction, snoring and other OSA-related symptoms were significantly improved. Twelve patients had normalized PSG and the severity of OSA improved significantly in 3 patients. The total effective rate of MDO for OSA was 60%. The statistical results showed that OAHI (P = 0.045) decreased and LSaO₂ (P = 0.009) increased significantly compared to preoperative values. MDO can improve OSA-related symptoms in CFM patients. In addition, respiratory function was improved in most patients after MDO, based on PSG. CFM patients, especially those with OSA, can benefit from MDO.

[Analysis on the novel compound heterozygous mutation FⅪ of a patient with hereditary factor Ⅺ deficiency]

Objective: To investigate the clinical phenotype and genotype characteristics of a Chinese hereditary factor Ⅺ deficiency pedigree. Methods: The activated partial thromboplastin time (APTT), prothrombin time (PT), FⅪ activity (FⅪ: C) were measured by clotting method using automatic coagulation analyzer. The FⅪ antigen (FⅪ: Ag) was assayed by enzyme-linked immunosorbent assay (ELISA). Fifteen exons of F11 from the proband and his pedigree members were amplified by polymerase chain reaction (PCR), then sequenced. Pymol software was used to analyze the novel mutations. Results: APTT, FⅪ: C and FⅪ: Ag of proband was 74.2 s, 4.0% and 2.9%, respectively. For his older sister, APTT, FⅪ: C and FⅪ: Ag was 67.1 s, 3.0% and 1.8%, respectively. APTT, FⅪ: C and FⅪ: Ag of healthy controls were 34.5 s, 100.0% and 100.0%. FⅪ: C of proband's father, mother and brother were 72.0%, 62.0%, and 78.0%, respectively. FⅪ: Ag of them were 50.0%, 43.0%, and 51.8%, respectively. The other coagulant parameters of the proband and his pedigree were all in the normal range. Sequence analysis showed two heterozygous gene mutations in F11 of the proband and his older sister. One was a deletion of T at nucleotide 1 491 in exon 12, resulting in a frameshift. A substitution of leucine 465 by tryptophan and a terminal coden after 7 amino acid: F11NM_13142c.1491delT (p.Leu465Trp.fs*7). The other was a G to A substitution at nucleotide 1 815 in exon 15, resulting in a substitution of glycine 573 by aspartic acid: F11 NM_13142c.1815G>A (p.Gly573Asp). F11NM_13142c.1491delT (p.Leu465Trp.fs*7) heterozygotes were found both in the proband's father and his brother while p. Gly573Asp heterozygote was only found in his mother. F11 of the proband's uncle was wild. Conclusion: The novel compound heterozygous mutations of F11NM_13142c.1491delT (p.Leu465Trp.fs*7) and F11 NM_13142 c. 1815G>A (p.Gly573Asp) are responsible for FⅪ deficiency to the proband, which induced the decrease of FⅪ: C and FⅪ: Ag.