| [objective]1. The research will determine whether births of patients with oral-facial clefts follow a seasonal pattern in a native Chinese population.2. To study the relationship between the distraction force and the age of the patients.To study postoperative maxillary stability and retraction rate. The impact on dental arch width, palate height,speech articulation and velopharyngeal closure status will also be determined.3. We use the zygomaticomaxillary suture of the male rat as the research object. We hope to find some age related biological changes which is related to the age related difficulty in maxillary complex distraction.[Methods]1. Patients with oral-facial clefts treated at the Plastic Surgery Hospital between2002.01-2011.12were retrospectively investigated. The controls consisting of all living births from the obstetric department of the third affiliated hospital of Peking university during2002.01-2011.12.Seasonal variations in months of births were analyzed by using χ2test.2.65patients were treated with trans-sutural distraction osteogenesis technique. To study①the change of face contour and occluding relation②maxillary stability and retraction rate with cephalometric mesurement③the change of dental arch width and palatal height with digital dental wax mesurement④the change of speech articulation and velopharyngeal closure status with the methods of subjective speech evaluation, nasopharynx fiber microscopy examination and X ray of lateral projection of cranium measurement.3. The SD male rats were divided into3groups (n=20),the age of each group is4week old(4w),3months old(3m) and13months old(13m). The age related changes of body, cranial facial sutures and periosteum were recorded. The age related changes of plasma amount of RANKL/OPG/ALP/OC were detected with Elisa and local tissue RANKL/OPG/ALP/OC/OX62/CD25mRNA were detected with RT-PCR. We also use histology and MicroCT to study age related changes of the zygomaticomaxillary suture. [results]1. seasonal researchA total of6193patients with oral-facial clefts and13254normal living newborns were included in this study. Birth time peaks of the patients occurred in autumn and winter,especially in October and January,compared with the nadir in the summer(P<0.05). The birth time peaks of male patients occurred in autumn and winter, especially in October, February and January. The birth time peaks of female occurred in autumn and winter,, especially in January, October and November. There was statistical difference in birth distribution in the different months (P<0.05) or four seasons (P<0.05) in females,No statistical difference was found in males (P>0.05).2. clinical researchI) All patients’face contour and occluding relation improved after treatment. No severe complications were found.II) There is no statistically significant difference of distraction force was found between the age below and more than11years old, but in older group the latency time is longer.III) From preoperative to the removal of RED,the A point average forward13.48mm and the SNA angle increased by an average of9.65°;within6months after the removal of RED,73%of patients with A point retreat22%,83%of patients with SNA angle decreased20%;within26.75months after the removal of RED,83%of patients with A point retreat23%,92%of patients with SNA angle decreased24.6%.IV) Dental arch width increased most obviously of UCLP without orthodontic treatment is the anterior segment,followed by the medial segment, and again posterior segment. Dental arch width increased most obviously of UCLP with orthodontic treatment is medial segment followed by posterior segment, and again the anterior segment. In the follow-up period, the UCLP with orthodontic treatment whose anterior and medial segment of dental arch width continue to increase,but the posterior segment narrowing. The palatal height of the UCLP without orthodontic treatment reduced,but the orthodontic group slightly increased.V)38%of patients increased speech articulation,54%of patients deteriorated speech articulation.69%of patients with velopharyngeal closure status have no change,31%of patients with velopharyngeal closure status deteriorated.92%of patients with soft palate length/pharyngeal depth ratio reduced. 3. Animal experiment1) From4w to3m old,the body weight,body and trunk length of the SD male rats increased345%,65%,61%respectively. When the rats were in adult,the length of the body and trunk will not increase obviously, but body weight still can significantly increased.2) From4w to13m old,the plasma amount of RANKL and OPG tend to decrease, but RANKL/OPG ratio tends to increase, both of them have no statistically significant. The value of plasma ALP and OC decreased and have statistically significant (P<0.05)3) From4w to13m old,At the tissue level the mRNA expression of RANKL and OPG tend to decrease,but the RANKL/OPG ratio and the amount of ALP tend to decrease,all of above have no statistically significant. The value of OC decreased and have statistically significant.;From4w to3m old,the amount of0X62and CD25tend to increase,but have no statistically significant.4) From4w to13m old, MicroCT shows the density of zygomaticomaxillary suture increased by8times and the density of bone increased by2times at the same time. The suture/bone density ratio increase from0.14:1in4w old to0.54:1in13m old.[conclusions]1. The data indicate that there is a possible seasonality in months of births of patients with oral-facial clefts in a native Chinese population and a difference between the genders. This approach could be useful for the study of the etiology and pathogenesis of oral-facial clefts.2. To treat midface hypoplasia with the technique of SDO have been achieved good results. With the patient’s age grows, the treatment will have more difficulty. After the removal of the RED, the maxillary complex will have an tendency to retreat, especially in the first six months, synchronizing orthodontic treatment is not helpful to the lateral expansion of the dental arch, but its long-term effect is better, and also beneficial to the palate height maintainment.38%of patients increased speech articulation,69%of patients with velopharyngeal closure status have no change, there is certain guiding significance of the soft palate length/pharyngeal depth ratio in judgment of postoperative velopharyngeal status.3. From4w to13m old,the body weight, body and trunk length significantly increased, but when the rats were in adult,only body weight increased obviously. The amount of plasma osteoblasts and osteoclasts related protein have a good consistency with mRNA quantitative in the local tissue. Till13months old,we didn’t found any sign of bone loss,but the activity of osteoblasts have been reduced. From4w to3m old, the amout of DC and activated T cell did not change significantly in local tissue. With the age increasing,the difference of the density between the suture and bone are getting smaller and smaller. Its texture and link is more close. And all of above can be the biological evidence to the age related difficulty with SDO technique. |
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