... Branchial cleft cysts form during development of the embryo . They occur when tissues in the neck area ( ... Elsevier Saunders; 2015:chap 19. Read More Cyst Fetal development Review Date 11/3/2015 Updated by: ...
Branchial cleft cyst, sinuses, and fistulae are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulty in diagnosis and surgical management. Here, I report a case of 14-year-old boy who presented with asymptomatic, congenital swelling located just below the jawline in the lateral part of the neck. The lesion was excised surgically. Histopathology showed the cyst lined by squamous as well as columnar ciliated epithelium, which was a characteristic finding of branchial cleft cyst. The aim of presenting this case is its rarity. PMID:27904209
Chen, Wei-Liang; Fang, Si-Lian
Second branchial cleft cysts (also called cervical lymphoepithelial cysts) usually present in adulthood, and cosmesis of surgical access is an important issue. This study was performed to assess the feasibility and outcome of a retroauricular approach for removing second branchial cleft cysts. Eight patients underwent removal of second branchial cleft cysts using a retroauricular approach. All 8 second branchial cleft cysts were removed successfully, and the wounds healed uneventfully. None of the patients suffered from weakness of the great auricular nerve. Marginal nerve palsy did not occur postsurgery. Average follow-up period was 14.5 months (range, 6-20 months) with no tumor recurrence. The incision scars were invisible. Second branchial cleft cyst resection using a retroauricular approach is a feasible method that provides an acceptable cosmetic outcome.
Chen, Liang-si; Sun, Wei; Wu, Pei-na; Zhang, Si-yi; Xu, Mi-mi; Luo, Xiao-ning; Zhan, Jian-dong; Huang, Xiaoming
This study evaluates the feasibility of endoscope-assisted second branchial cleft cyst resection via retroauricular approach by comparing it with conventional cervical incision for removal of second branchial cleft cyst. From January 2009 to December 2010, 25 patients were randomly assigned to the endoscope-assisted surgery group (13 patients) or the conventional surgery group (12 patients). The clinical characteristics of patients, operation time, operative bleeding volume, postoperative complications, and subjective satisfaction with incision scar checked by visual analog scale were compared between the groups, retrospectively. All 13 second branchial cleft cyst resections were successfully performed endoscopically, and the wounds healed uneventfully. Endoscope-assisted surgery lasted 54.6 ± 6.3 min, and conventional surgery lasted 49.6 ± 6.9 min (P = 0.069). Degree of bleeding volume did not differ between the groups (P = 0.624). Mean patient satisfaction score was 9.2 ± 0.6 in the endoscope-assisted surgery group and 6.2 ± 0.8 in the controls (P < 0.001). All 13 patients in the endoscope-assisted surgery group were satisfied with their cosmetic results. One case showed temporary numbness around the earlobe that recovered within 1 month after surgery. No marginal nerve palsy occurred. No complications such as bleeding, salivary fistula, or paresis of the marginal mandibular branch occurred. All 25 patients were disease free with follow-up of 6-24 months (median 16 months). Endoscope-assisted second branchial cleft cyst resection via retroauricular approach is a feasible technique. This procedure may serve as an alternative approach that allows an invisible incision and better cosmetic results.
SOOSARAEI, Masoud; ALIZADEH, Shahriar; FAKHAR, Mahdi; BANIMOSTAFAVI, Elham Sadat
We report an unusual case of primary hydatid cyst of the mandibular angle without glands involvement, in the left supraclavicular region of the neck with no involvement of any other regions of the body. In July 2012, a 25-yr old woman, from Golestan Province, Northeast Iran was admitted to our ENT Clinic, with one-year history of a progressively increasing swelling, pain and gradually growing mass located in the left side of neck region. The patient was diagnosed by Fine Needle Aspiration Cytology (FANC) and histopathology examination. Hydatid cyst should be considered in differential diagnosis of soft tissue mass such as branchial cleft cyst (BCC) and or dermoid cyst in the cervical region especially in endemic areas. Moreover, FANC could be recommended as a valuable, rapid, simple, and safe procedure to diagnose hydatid cyst especially in unusual locations. PMID:28127373
Roh, Jong-Lyel; Yoon, Yeo-Hoon
Branchial cleft cyst (BCC) is treated surgically using a transcervical approach, leaving potential cervical scars. This prospective study assessed the outcomes of retroauricular hairline incision (RAHI) approach for BCC excision in children. Twelve patients with second BCC (age < 18 years) underwent cyst excision via the RAHI approach, with incision along the postauricular sulcus and hairline. The operation time, complications, and subjective satisfaction with incision scars were assessed. Mean operation time was 45 +/- 12 min. There were no significant complications, except for temporary hypoesthesia of the earlobe. Hypertrophic scars at incision sites occurred in two patients, but these scars are usually hidden by the natural hair and auricle. Mean subjective satisfaction score regarding incision scars was 8.7 +/- 0.9 out of 10. The RAHI approach may provide good aesthetic results without significant surgical morbidities. This may be an alternative option for the surgical excision of BCC for children and their parents who desire invisible external scars after surgery.
Sai-Guan, Lum; Min-Han, Kong; Kah-Wai, Ngan; Mohamad-Yunus, Mohd-Razif
Introduction: Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer’s ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed. Case Report: A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma. Conclusion: Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass. PMID:28393061
Chen, Liangsi; Huang, Xiaoming; Lou, Xiaonin; Xhang, Siyi; Song, Xinhan; Lu, Zhongming; Xu, Mimi
To assess the feasibility, risks and advantages of endoscope-assisted second branchial cleft cyst (SBCC) resection via the retroauricular hairline approach (RHA) by comparing with conventional trans cervical approach. Using prospective clinical controlled study, in twenty five patients with SBCC, 13 cases underwent endoscope-assisted resection via the RHA, 12 cases underwent conventional transcervical approach resection. Preoperatively, the sizes, locations and adjacency of all lesions were evaluated by ultrasonography, CT or MRI. Pathologic diagnoses of all cases were identified as SBCC using fine needle aspiration biopsy. Two groups were compared at length of incision, operation time, bleeding, incision cosmetic result, complication etc. All 25 operations were successfully performed. Length of incision and operation time in endoscopic group were significantly longer than that of the transcervical group (P < 0.05). After three months, the mean subjective satisfaction score of incision scar in the endoscopic group was significantly higher than that of transcervical group (P < 0.01). In endoscopic group, 1 cases (7.7%) with temporary numbness of earlobe and 1 case (7.7%) with a darkened color change of the flap margin at the incision angle were found postoperatively. However, they were recovered within 1 month. All the 25 patients were disease free with a follow-up from 18 to 36 months (median follow-up: 26 months). Endoscope-assisted SBCC resection via RHA is feasible and safe for the treatment of SBCC. In comparison with the transcervical approach, this method can provide an invisible incision and better cosmetic re suits without significant complications.
Ming, Jia; Fan, Ziyi; Gong, Yu; Yuan, Qiaoying; Zhong, Ling; Fan, Linjun
Branchial cleft cysts are prone to recurrence and secondary infections, and hence, surgical resection is necessary. These masses are traditionally removed through an overlying incision; however, the resulting scar can be considered aesthetically displeasing. We accomplished a case of endoscopic resection of branchial cleft cyst in the right side of the neck of an 18-year-old female patient. Incisions were made in the bilateral mammary areolae and right axilla of the patient. We completely resected the mass using an ultrasonic scalpel and electrocoagulation hook within 45 minutes. All of the procedures were finished on the deep face of platysma muscle, which was not severed. There was no significant bleeding during the operation and the postoperative recovery was smooth, without recurrence for 6 months. The endoscopic resection of the neck mass through bilateral areolae and axillary incisions is simple, safe, and feasible, because there were covert incisions and fewer complications.
LeBert, Brad; Weiss, Sean; Johnson, Jonas; Walvekar, Rohan
To report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review. Retrospective case series. A retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological, and radiological data was recorded. A web-based search was conducted to identify relevant scientific literature on "retroauricular hairline incision /approach" in order to present a systematic review of current literature. In both cases, the SBCC (6.0 cm and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of ear lobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid, or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation. In conclusion, the RAHI offers an excellent surgical outcome and cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.
Chen, Junming; Chen, Weixiong; Zhang, Jianli; He, Fayao; Zhu, Zhaofeng; Tang, Sucheng; Wang, Yuejian
The aim of the study is to report the feasibility of endoscope-assisted second branchial cleft cyst resection via a small incision along the skin line on the lateral neck. In total, 41 patients from the Department of Otolaryngology, Foshan Hospital of Yat-sen University were randomly assigned to conventional (20 patients) or endoscope-assisted (21 patients) second branchial cleft cyst resection. The patient clinical characteristics, operation time, operative bleeding volume, postoperative complications, and subjective satisfaction with the incision scar (measured using a visual analog scale) were compared between the groups. All 41 s branchial cleft cyst resections were successfully performed, and the wounds healed uneventfully. The bleeding volume (6.3 ± 2.5 ml) and incision length (2.7 ± 0.3 cm) differed between the groups (P < 0.00). The mean patient satisfaction score was 8.0 ± 0.8 in the endoscope-assisted surgery group and 6.4 ± 0.9 in the control group (P < 0.00). All of the patients in the endoscope-assisted surgery group were satisfied with their cosmetic results. No marginal nerve palsy occurred. No complications such as bleeding, salivary fistula, or paresis of the marginal mandibular branch occurred. All of the patients were disease free through a follow-up period of 6-24 months (median: 14 months). Endoscope-assisted second branchial cleft cyst resection via a small incision along the dermatoglyph on the lateral neck is a feasible technique. This procedure may serve as an alternative approach, allowing a minimally invasive incision and better cosmetic results.
Larem, Aisha; Sheikh, Rashid; Al Qahtani, Abdulsalam; Khais, Frat; Ganesan, Shanmugam; Haidar, Hassan
We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224-E226, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Alyono, Jennifer C; Hong, Paul; Page, Nathan C; Malicki, Denise; Bothwell, Marcella R
Branchial cleft cysts, sinuses, and fistulas are the most common congenital lateral neck lesions in children. They arise as a result of an abnormal development of the branchial arches and their corresponding ectoderm-lined branchial clefts. Of these diverse anomalies, second branchial cleft lesions are the most common, accounting for approximately 95% of all branchial arch pathologies. We describe what is to the best of our knowledge the first reported case of an ectopic tooth in a branchial cleft anomaly. The patient was a young girl who had other congenital abnormalities and syndromic features and who was eventually diagnosed with Townes-Brocks syndrome. We describe the clinical presentation, management, pathologic analysis, and postoperative outcomes of this case, and we present a brief review of Townes-Brocks syndrome.
Beaufrère, Hugues; Castillo-Alcala, Fernanda; Holmberg, David L; Boston, Sarah; Smith, Dale A; Taylor, W Michael
A 37-year-old yellow-crowned Amazon parrot (Amazona ochrocephala) and a 20-year-old red-lored Amazon parrot (Amazona autumnalis) each presented with a large mass localized on the lateral neck. With the first bird, there was no evidence of signs of pain or discomfort, and the bird prehended and swallowed food normally. The second bird showed signs of mild upper-gastrointestinal discomfort. Results of an ultrasound examination and aspiration of the mass on each bird revealed a cystic structure. A computed tomography performed on the second bird revealed a large polycystic mass connected to the pharynx by a lateral tract. During surgical resection, both masses were found to originate from the subpharyngeal area. Based on topography and the histopathologic and immunohistochemical results, the masses were determined to be a second branchial cleft cyst for the first case and a second branchial pouch cyst for the second case. In addition, a carcinoma was present in situ within the epithelium of case 1, and the cyst in case 2 was secondarily infected. Branchial cysts are uncommonly diagnosed in veterinary and human medicine. These 2 cases are the first documented in parrots and appear similar to second branchial cysts reported in adult humans.
Hardee, P. S.; Hutchison, I. L.
Two patients with metastatic squamous cell carcinoma are presented. Both were initially clinically diagnosed as branchial cysts. The importance of a full examination of the upper aerodigestive tract, and fine needle aspiration cytology is emphasised to avoid the possibility of excision as a branchial cyst, which could lead to tumour dissemination. Images Figure 1 Figure 2 PMID:10645169
Gilabert Rodríguez, R; Berenguer, B; González Meli, B; Marín Molina, C; de Tomás Palacios, E; Buitrago Weiland, G; Aguado del Hoyo, A
First branchial arch cysts are uncommon. Therefore, together with its variable clinical and age presentation they are often misdiagnosed at first. The treatment is surgical, requiring a correct procedure to avoid future recurrences. In this paper we describe a typical case of first branchial arch cyst in which as described in other reports, we first made several misdiagnoses and therefore an inadequate treatment and lastly, with the correct diagnosis, we performed a meticulous complete excision under facial nerve monitoring.
Pahlavan, Shane; Haque, Waqar; Pereira, Kevin; Larrier, Deidre; Valdez, Tulio A
To identify the most common pathogens involved in infections of third and fourth branchial pouch cysts. Third and fourth branchial pouch cyst infections are an uncommon cause of anterior neck abscesses often confused with other entities, such as thyroglossal duct cysts and thyroid abscesses leading to misdiagnosis, recurrence, and increased morbidity related to a delay in diagnosis and appropriate treatment. Retrospective chart and literature review. Retrospective chart review case series of patients presenting to the Bobby R. Alford Department of Otolaryngology at Texas Children's Hospital from July 2004 to July 2008 with third and fourth branchial pouch cysts. A total of 11 patients were identified. All patients had left-sided lesions. Eikenella corrodens was found in 60% of cultures and was the most common organism identified in our patient group. Furthermore, 56% of the organisms isolated were anaerobic. All organisms with the exception of Staphylococcus aureus were identified as oral cavity flora. Third and fourth branchial pouch cysts provide a communication between the neck and the oral cavity through pyriform sinus tracts. The presence of oral cavity flora in a left anterior neck abscess should raise the suspicion of a branchial pouch anomaly, and subsequently alter therapeutic management.
Magdy, Emad A; Ashram, Yasmine A
First branchial cleft (FBC) anomalies are uncommon. The aim of this retrospective clinical study is to describe our experience in dealing with these sporadically reported lesions. Eighteen cases presenting with various FBC anomalies managed surgically during an 8-year period at a tertiary referral medical institution were included. Ten were males (56 %) and eight females (44 %) with age range 3-18 years. Anomaly was right-sided in 12 cases (67 %). None were bilateral. Nine patients (50 %) had prior abscess incision and drainage procedures ranging from 1 to 9 times. Two also had previous unsuccessful surgical excisions. Clinical presentations included discharging tract openings in external auditory canal/conchal bowl (n = 9), periauricular (n = 6), or upper neck (n = 4); cystic postauricular, parotid or upper neck swellings (n = 5); and eczematous scars (n = 9). Three distinct anatomical types were encountered: sinuses (n = 7), fistulas (n = 6), and cysts (n = 5). Complete surgical excision required superficial parotidectomy in 11 patients (61 %). Anomaly was deep to facial nerve (FN) in three cases (17 %), in-between its branches in two (11 %) and superficial (but sometimes adherent to the nerve) in remaining cases (72 %). Continuous intraoperative electrophysiological FN monitoring was used in all cases. Two cases had postoperative temporary lower FN paresis that recovered within 2 months. No further anomaly manifestation was observed after 49.8 months' mean postoperative follow-up (range 10-107 months). This study has shown that awareness of different presentations and readiness to identify and protect FN during surgery is essential for successful management of FBC anomalies. Intraoperative electrophysiological FN monitoring can help in that respect.
Carta, Filippo; Sionis, Sara; Mascia, Luigi; Puxeddu, Roberto
Branchial malformations are common congenital head and neck lesions usually diagnosed in childhood during the first decade of life. Acute presentation is usually managed with conservative protocols before a definitive surgical procedure although the risk of life-treating septic complications may influence the physician's decision. Surgery is the treatment of choice with the removal of the lesion alone, nevertheless more aggressive approaches must be considered in complicated cases. Selective neck dissection including the removal of part of the thyroid lobe with the congenital lesion should be considered as the "ultima ratio" treatment to avoid recurrence. We reviewed literature and report our experience concerning two patients with fourth branchial cleft sinus. A three-year-old child with a clinical history of recurrent neck abscess was referred to our department after several drainages performed in another centre. A three-year-old child referred to our department for a left side lower primary neck abscess. In both cases the diagnosis of a complicated fourth cleft remnant was confirmed by rigid endoscopic visualization of the mucosal orifice of the sinus in the pyriform fossa. Surgical management during acute presentation was challenging; in one patient the early fasciitis required an emergency procedure to remove the infected sinus that were strictly adherent to the deep vascular-nervous axis. Surgery was the definitive treatment in both cases and at 12 and 25 months follow-up respectively no recurrences were observed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Piccioni, Michela; Bottazzoli, Marco; Nassif, Nader; Stefini, Stefania; Nicolai, Piero
We present a new method of optimizing the results of surgery for branchial cleft anomalies based on the intraoperative injection of fibrin glue combined with methylene blue dye. Retrospective single-center cohort study. The method was applied in 17 patients suffering from branchial anomalies. Six (35.29%) had a preauricular lesion; three (17.65%) had lesions derived from the first arch/pouch/groove (type I), four (23.53%) had lesions derived from the first (type II), one (5.88%) had lesions derived from the second, one (5.88%) had lesions derived from the third, and two (11.76%) had lesions derived from the fourth. The median and mean age at surgery were 10 and 10.6 years, respectively. All patients were followed by periodic clinical and ultrasonographic examination. The combination of fibrin glue with methylene blue facilitated the correct assessment of the extension of the lesions and their intraoperative manipulation. After a mean follow-up of 47.8 months, all patients were free of disease. Intraoperative injection of branchial fistulae and cysts by a mixture of fibrin glue and methylene blue is an effective, easy, and safe tool to track lesions and achieve radical resection. The technique requires a definitive validation on a large cohort with adequate stratification of patients. 4 Laryngoscope, 126:2147-2150, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Leask, Rhoda; Pettey, Kenneth P; Bath, Gareth F
Congenital malformations of the branchial arches, clefts and grooves have not been previously reported in sheep. These defects may be due to infectious agents (especially viruses), toxins or genetic abnormalities. Defects were reported in two of a set of quadruplet lambs born prematurely to an eight-tooth Mutton Merino ewe. The lambs weighed between 2.0 kg and 2.5 kg; this is below the normal expected birth weight of 3.5 kg for quadruplet lambs, below which viability is compromised. The firstborn lamb was severely affected by bilateral oroauricular fistulae. The second lamb was unilaterally affected on the right, less severely than the first. The third lamb was normal and the fourth was mummified. The occurrence of another case in this small flock almost a decade earlier indicates that there could be genetic involvement.
Chan, Kai-Chieh; Chao, Wei-Chieh; Wu, Che-Ming
This is a detailed description of the clinical and anatomical presentation of the first branchial cleft anomaly presenting as retroauricular infected mass. Our experience with a microscopic dissection with control of the sinus lumen from within the cyst is also described. Between 2001 and 2008, patients with the final histologic diagnosis of first branchial cleft anomaly in the retroauricular area were managed with a microscopic dissection technique with control of the sinus lumen from within the cyst. Classifications were done in accordance with Work, Olsen, and Chilla. Outcomes measured intervention as a function of disease recurrence and complications including facial nerve function was used. Eight patients with a mean age of 14.2 years were enrolled, and this included 4 females and 4 males. Four type 1 and 4 type 2 lesions as per the Work's and Chilla's classification were found, and there were 5 sinuses, 2 fistulae, and 1 cyst according to Olsen's classification. All patients presented to the department with acute infection at the time of diagnosis. Five of the 8 patients had previous surgical treatment, 2 of those had up to 3 previous operations. None of the patients were complicated by disease recurrence or had surgical related complications (facial nerve paresis or paralysis, infection, canal stenosis) requiring reoperation with more than 1 year of follow-up. First branchial cleft anomaly presenting as retroauricular infected mass can be effectively treated by adopting a microscopic dissection technique with control of the sinus lumen from within the cyst. Copyright © 2012 Elsevier Inc. All rights reserved.
An 11 years old boy came, with complain of mild dysarthria. Examination revealed marked hemiatrophy of left side of the tongue. Five months back he underwent ipsilateral branchial cyst operation. To our knowledge, no case was reported. After branchial cyst operation if there is any residual remnant chance of recurrence is very high. PMID:22296879
Sun, Zhipeng; Fu, Kaiyuan; Zhang, Zuyan; Zhao, Yanping; Ma, Xuchen
The aim of this study was to primarily investigate the usefulness of computerized tomographic (CT) fistulography in the diagnosis and management of branchial cleft fistulae and sinuses. Fifteen patients with confirmed branchial fistulae or sinuses who had undergone CT fistulography were included. The diagnoses were confirmed by clinical, radiologic, or histopathologic examinations. The internal openings, distribution, and neighboring relationship of the lesions presented by CT fistulography were analyzed to evaluate the usefulness in comparison with x-ray fistulography. Nine patients were diagnosed with first branchial fistulae or sinuses, 2 with second branchial fistulae, and 4 with third or fourth branchial fistulae. The presence and location of the lesions could be seen on x-ray fistulography. The distribution of the lesions, internal openings, and neighboring relationship with parotid gland, carotid sheath, and submandibular gland could be clearly demonstrated on CT cross-sectional or volume-rendering images. CT fistulography could provide valuable information and benefit surgical planning by demonstrating the courses of branchial anomalies in detail. Copyright © 2012 Elsevier Inc. All rights reserved.
Nicollas, R; Tardivet, L; Bourlière-Najean, B; Sudre-Levillain, I; Triglia, J M
To report two cases of an undescribed association of first branchial cleft fistula and middle ear congenital cholesteatoma and to discuss management and embryological hypothesis. Retrospective study and review of the literature Both patients were young girls free of past medical or surgical history. Surgical removal of the first cleft anomaly found in the two cases a fistula routing underneath the facial nerve. Both cholesteatomas were located in the hypotympanum, mesotympanum. In one case, an anatomical link between the two malformations was clearly identified with CT scan. The main embryological theories and classification are reviewed. A connection between Aimi's and Michaels' theories (congenital cholesteatoma) and Work classification might explain the reported clinical association.
Huang, S L; Zhang, B; Chen, L S; Liang, L; Luo, X N; Lu, Z M; Zhang, S Y
Objective: To report rare cases of congenital neck cutaneous sinus with an orifice near the sternoclavicular joint and to investigate their origins and managements. Methods: A total of ten patients with congenital neck cutaneous sinus having an orifice near the sternoclavicular joint treated in the Guangdong General Hospital from January 2010 to June 2015 were retrospectively analyzed. Results: There four boys and six girls, aging from 11 months to 96 months with an average of 33.4 months, and they had a common feature showing a congenital cutaneous sinus with an orifice near sternoclavicular joint. Discharge of pus from the orifice or abscess formation was commonly seen soon after infection. With bacteriological study, staphylococcus aureus was positive in five cases and klebsiella pneumonia in a case. Another orifice of fistula/sinus was not depicted in pyriform with barium swallow X-ray in five cases Ultrasound studies of three cases demonstrated anechoic (i.e., nearly black) and solid-cystic lesion near sternoclavicular joint with posterior acoustic enhancement. Magnetic resonance imaging (MRI) showed isointensity of the lesion on T1 and T2 weighted images with heterogeneous enhancement and a close relationship with sternoclavicular joint. All patients underwent laryngoscopic examination, which showed no orifice of sinus in pyriform at same side. Surgical resection of fistula/sinus was performed in all cases. The lengths of the fistula varied from 5 mm to 22 mm with an average of 11 mm. Postoperative pathological examination showed all specimens were accordance with fistula. No complications were noticed. Recurrence was not observed in the cases by following-up of 6 months to 70 months (median: 33 months). Conclusion: Congenital neck cutaneous sinus with orifice near the sternoclavicular joint maybe a special clinical phenotype of the fourth branchial cleft sinus with skin orifice in cervicothoracic junction. Differential diagnoses between low cervical diseases
Yang, Chengxian; Bao, Xinjie; Liu, Xiaohai; Deng, Kan; Feng, Ming; Yao, Yong; Wang, Renzhi
Abstract Background: Rathke cleft cyst (RCC) is a rare cystic sellar entity, which is usually small in size and asymptomatic in most patients. RCC presenting panhypopituitarism and a cystic lesion with rim enhancement on magnetic resonance imaging is extremely rare. Therefore, it is easy to be misdiagnosed as pituitary abscess because of the similar clinical manifestations and neuroimaging changes. Case summary: We report a rare case of RCC masquerading as pituitary abscess clinically and radiologically with no evidence of central nervous system infection. The patient was initially suspected to be diagnosed with pituitary abscess, which was denied by the histopathological findings of RCC with no intraoperative drainage of abscess. We present an uncommon case of RCC masquerading as pituitary abscess in a 62-year-old Chinese male patient. The patient was admitted to Peking Union Medical College Hospital complaining of severe frontal pulsatile headache, visual acuity deficit, polyuria, polydipsia, and slight disturbance of consciousness. The biochemical and endocrinological examinations revealed severe hyponatremia and panhypopituitarism. Magnetic resonance imaging showed a sellar lesion with the apparent cystic change and rim enhancement. Accordingly, pituitary abscess was misdiagnosed at the beginning. The patient received hormone replacement therapy and underwent a trans-sphenoidal surgery. The surgical findings were uneventful. The histopathological examinations showed no infiltration of inflammatory cells or pus, and proved the lesion to be RCC. Conclusion: Through this rare case, we aim to emphasize that the differential diagnosis of sellar lesions requires constant vigilance and that RCC may lead to clinical and radiological changes similar with pituitary abscess. PMID:28272259
Vure, Srinivas; Pang, Karl; Hallam, Lavinia; Lui, M; Croaker, David
Congenital midline cervical cleft (CMCC) is an uncommon malformation. We report a case of a baby girl aged 3 days with a CMCC associated with a cyst reported as a bronchogenic cyst (BC). The pathology is not specific. The association of BC and CMCC is extremely rare and only five cases have been found in the literature. We report our case and review the relevant literature.
Yuan, Yongyi; Zhang, Guozheng; Wang, Guojian; Huang, Deliang; Liu, Liangfa; Wu, Wenming; Wang, Jialing
To analysis the therapeutic procedure on the recurrent congenital fistula or cyst in lateral cervical part. Thirty-nine cases with recurrent congenital fistula or cyst in lateral cervical part were enrolled in this study including 12 cases from the first branchial cleft, 6 from the second branchial cleft and 21 from the third branchial cleft. All the cases underwent fistula or cyst excision for 2 to 5 times in their whole therapeutic process, not counting the incision and drainage. During 9 months to 17 years follow-up, fistula or cyst in 6 cases relapsed,including 1 fistula from the first branchial cleft,3 fistulae from the second branchial cleft, 1 fistula and 1 cyst from the third branchial cleft, respectively. One case with recurrent fistula from the first branchial cleft was diagnosed temporal verrucous carcinoma six months after the third fistula excision operation and died one year after the forth operation probably due to the intracranial metastasis of temporal bone verrucous carcinoma. In two cases, the fistulae went through the thyroid gland to the piriform fossa and both the fistulae and part of the thyroid glands were resected. In the patients whose inner orificium fistulae were found and ligated effectively,no recurrence occurred during the followed-up period. The key point to cure the recurrent congenital fistula or cyst in lateral cervical part lies in proper occasion of operation, stain tracing in operation and reasonable program of operation.
Mrelashvili, Anna; Braksick, Sherri A; Murphy, Lauren L; Morparia, Neha P; Natt, Neena; Kumar, Neeraj
Rathke's cleft cysts (RCC) are usually benign, sellar and/or suprasellar lesions originating from the remnants of Rathke's pouch. Rarely, RCC can present with chemical meningitis, sellar abscess, lymphocytic hypophysitis, or intracystic hemorrhage. We describe an unusual presentation of RCC in which the patient presented with a clinical picture of chemical meningitis consisting of meningeal irritation, inflammatory cerebrospinal fluid profile, and enhancing pituitary and hypothalamic lesions, in addition to involvement of the optic tracts and optic nerve.
O’Neill, Brian T.; Segkos, Konstantinos; Kasper, Ekkehard M.; Pallotta, Johanna A.
Primary intracranial and sellar squamous cell carcinoma is an extremely rare entity, usually caused by malignant transformation of epidermoid cysts, or very rarely other non-malignant epithelial cysts. Malignant transformation of a Rathke’s cleft cyst has never been described. We present a 49-year-old male patient who presented with a 3-month history of progressive frontotemporal headaches. Imaging revealed a 1.2 cm cystic pituitary mass consistent with a hemorrhagic Rathke’s cleft cyst. The patient underwent trans-sphenoidal resection of the pituitary cyst, and pathologic analysis revealed a squamous cell carcinoma lining a Rathke’s cleft cyst. Extensive imaging and otorhinolaryngologic evaluation revealed no primary source for metastasis. We feel this represents the first case of a patient with a pituitary lesion in which presentation and MRI imaging were consistent with Rathke’s cleft cyst, yet histology revealed squamous cell carcinoma in situ. PMID:25715776
Kamei, Takamasa; Nonaka, Masahiro; Uemura, Yoshiko; Yamanouchi, Yasuo; Komori, Yumiko; Iwata, Ryoichi; Takeda, Junichi; Hashiba, Tetsuo; Yoshimura, Kunikazu; Asai, Akio
Rathke's cleft cyst is a cystic disease that occurs in the sella turcica or, occasionally, in the suprasellar area. An ectopic Rathke's cleft cyst is extremely rare, and its nature is less well understood. The authors report the case of a 14-year-old girl who presented with a growing cystic lesion in the prepontine cistern, immediately behind the dorsum sellae. Preoperative imaging and intraoperative investigation showed part of the cyst wall continuing into the dorsum sellae, to the pituitary gland. The cisternal portion of the cyst wall was totally resected via a right subtemporal approach. Histopathological examination of the cyst wall showed a monolayer of ciliated cells, identical to those of Rathke's cleft cyst. To the best of the authors' knowledge, this represents the first pediatric case of Rathke's cleft cyst occurring in the prepontine cistern.
Kobayashi, Namie; Oshitari, Toshiyuki; Kobayashi, Kentaro; Onoda, Takatsugu; Ikeda, Hidetoshi; Adachi-Usami, Emiko
We report a case of right optic neuritis caused by Rathke's cleft cyst (RCC) in a young adult. A 15-year-old boy presented with reduced visual acuity in the right eye. He was diagnosed with optic neuritis in the right eye 4 years earlier at other clinics before he was referred to our department. During our one-year examinations, the cause of the reduced vision in his right eye could not be determined conclusively. At the age of 17 years, a RCC was detected by a neurosurgeon who specialized in hypophyseal diseases. He underwent microscopic transsphenoidal resection of the cyst, and his vision recovered to 1.2 and he has had no recurrence for at least 9 months. We suggest that repeated rupturing of the RCC was the cause of the optic neuritis, and a RCC can be successfully treated by surgery even after 3 years of optic neuritis. PMID:25045561
Gao, Mingtong; An, Yanyan; Huang, Zhihong; Niu, Jianyi; Yuan, Xunhui; Bai, Yun'an; Guo, Liemei
Both of Pituitary adenoma (PA) and Rathke cleft cyst (RCC) are the most common and benign sellar lesions. Generally, the origin of RCC is considered to be derived from remnants of Rathke punch, while PA is formed by proliferation of the anterior wall of Rathke pouch. Although they have a possibility to share a common embryological origin, the coexistence of PA and RCC is extremely rare. Here, the authors report a 50-year-old male patient who was found to have a large cystic sellar lesion, and surgical resection revealed components of a RCC coexisting with a PA. This collision reminded us of the possibility of RCC coexisting with PA. Furthermore, a clinicopathologic relation of them were reviewed and investigated.
Babu, Ranjith; Back, Adam G.; Komisarow, Jordan M.; Owens, Timothy R.; Cummings, Thomas J.; Britz, Gavin W.
Pituitary adenomas and Rathke's cleft cysts (RCCs) share a common embryological origin. Occasionally, these two lesions can present within the same patient. We present a case of a 39-year-old male who was found to have a large sellar lesion after complaints of persistent headaches and horizontal nystagmus. Surgical resection revealed components of a RCC co-existing with a pituitary adenoma. A brief review of the literature was performed revealing 38 cases of co-existing Rathke's cleft cysts and pituitary adenomas. Among the cases, the most common symptoms included headache and visual changes. Rathke's cleft cysts and pituitary adenomas are rarely found to co-exist, despite having common embryological origins. We review the existing literature, discuss the common embryology to these two lesions and describe a unique case from our institution of a co-existing Rathke's cleft cyst and pituitary adenoma. PMID:24551002
Lim, Han Hyuk
Purpose This study evaluated the clinical manifestations of and risk factors for pituitary insufficiency in children and adolescents with Rathke's cleft cysts. Methods Forty-four patients with Rathke's cleft cysts younger than 19 years who visited Seoul National University Children's Hospital between January 1995 and September 2009 were enrolled. Rathke's cleft cysts were confirmed histologically through an operation in 15 patients and by brain magnetic resonance imaging (MRI) in 29 patients. The clinical, hormonal, and imaging features were reviewed retrospectively. Results The clinical presentation of symptomatic patients was as follows: headache (65%), endocrinopathy (61%), and visual disturbance (19%). Endocrinopathy included central precocious puberty (18%), diabetes insipidus (14%), general weakness (11%), and decreased growth velocity (7%). After surgery, hyperprolactinemia resolved in all patients, but growth hormone insufficiency, hypothyroidism, and diabetes insipidus did not improve. Pituitary insufficiency except gonadotropin abnormality correlated significantly with severe headache, visual disturbance, general weakness, and cystic size. Suprasellar extension of cysts and high signals in the T2-weighted image on brain MRI were related to hypothyroidism, hypocortisolism, and diabetes insipidus. Multivariable linear regression analysis showed that only general weakness was a risk factor for pituitary insufficiency (R2=0.549). Conclusion General weakness is a risk factor for pituitary insufficiency in patients with Rathke's cleft cysts. When a patient with a Rathke's cleft cyst complains of general weakness, the clinician should evaluate pituitary function and consider surgical treatment. PMID:21189952
Fan, Jun; Peng, Yuping; Qi, Songtao; Zhang, Xi-an; Qiu, Binghui; Pan, Jun
An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra- and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15). Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC
Mendelson, Zachary S; Husain, Qasim; Elmoursi, Sedeek; Svider, Peter F; Eloy, Jean Anderson; Liu, James K
Rathke's cleft cysts (RCC) arise from the development of the Rathke's cleft pouch. These commonly occurring cysts are typically asymptomatic, but sometimes present with headaches, endocrine dysfunction, and visual loss. Recurrence is common after either drainage or surgical removal. The purpose of this study was to review published outcomes for RCC management, and determine whether specific factors, including patient demographics, cyst pathology, radiologic parameters, or surgical techniques predispose to their recurrence. A systematic review of studies for RCC from 1990 to 2012 was conducted. Patients were identified using a Medline/PubMed search, and from the bibliographies of relevant articles obtained from the primary search. Relevant studies reporting recurrence rate were identified, and data were extracted regarding patient demographics, presenting symptoms, cyst characteristics, surgical treatment, and outcomes. A meta-analysis for recurrence rates was also performed. Twenty-eight journal articles comprising a total of 1151 RCC revealed an average follow-up of 38 months (range 16-79 months). In the studies reviewed, there was a relatively equal distribution of treatment approaches, with 35% subtotal resection, 33% gross total resection, and 32% complete drainage with wall biopsy. The microsurgical transsphenoidal approach was found to have a higher recurrence rate (14% versus 8%) and new endocrine dysfunction rate (25% versus 10%) compared to the endoscopic approach. The data demonstrates a notable overall recurrence rate for RCC (12.5%). However, there appears to be no conclusive evidence that more aggressive resection of the cyst wall results in lower rates of recurrence.
Chin, Rina; Niitsu, Yoshihiro; Sekine, Tetsuo; Niwa, Arisa; Ogawa, Yoshihiro; Hirata, Yukio
A 73-year-old woman admitted to our hospital because of headache, poor appetite, malaise, weight loss, and vomiting was found to have central adrenal insufficiency and thyrotoxicosis due to silent thyroiditis. Polyuria developed after replacement with glucocorticoid (masked diabetes insipidus), which was controlled with nasal administration of desmopressin. Magnetic resonance imaging of the brain showed a large cystic pituitary mass (18 × 18 × 12 mm) extending suprasellarly to the optic chiasm. Transsphenoidal surgery revealed that the pituitary tumor was Rathke's cleft cyst. Following surgery, replacement with neither glucocorticoid nor desmopressin was needed any more. Therefore, it is suggested that Rathke's cleft cyst is responsible for the masked diabetes insipidus and the central insufficiency. Furthermore, it is speculated that thyrotoxicosis with painless thyroiditis might induce changes from subclinical adrenal insufficiency to transiently overt insufficiency. PMID:25431697
Culver, Silas A; Grober, Yuval; Ornan, David A; Patrie, James T; Oldfield, Edward H; Jane, John A; Thorner, Michael O
Rathke cleft cysts (RCCs) are benign embryonic remnants of the Rathke's pouch found in 13% to 33% of the general population. When symptomatic, they manifest themselves by compressing adjacent structures, causing pressure effects such as headache, visual disturbance, or pituitary hormone deficits. Most RCCs are asymptomatic, and their management remains controversial. Surgical resection has generally been indicated to treat symptomatic RCCs but carries the risk of complications. Our objective was to better characterize the outcomes for patients with presumed RCCs undergoing conservative management. This was a retrospective cohort study. The setting was a pituitary program at a university medical center. The participants were 75 patients with radiographically diagnosed RCCs. All brain magnetic resonance imaging (MRI) scans performed at the University of Virginia from 2006 through 2013 were searched for the words "Rathke cleft cyst," and pituitary clinic notes from 2007 to 2012 were reviewed for patients identified as probably having an RCC. Images for all patients were reviewed by the interpreting neuroradiologist, and those patients with at least 2 MRI scans were included. The dimensions of each cyst were assessed by the same neuroradiologist, and the volume of each cyst was analyzed as a function of the time from the first image obtained. A total of 75 patients (4-76 years old) met our inclusion criteria. The length of follow-up was 1 to 126 months (median 24 months). In 43 patients (57%) no detectable change in the size of their cysts was seen, in 21 patients (28%) cysts increased in size, and in 11 patients (15%) cysts decreased in size. The predicted mean cyst growth rate was not significantly different from 0. The increasingly prevalent use of brain imaging modalities such as MRI has resulted in an increase in the incidental discovery of pituitary lesions. Our study demonstrates that the majority of radiologically diagnosed RCCs remain unchanged or decrease in
Asano, Tomoko; Yamada, Hodaka; Yoshida, Masashi; Aoki, Atsushi; Ikoma, Aki; Kusaka, Ikuyo; Toyoshima, Hideo; Kakei, Masafumi; Ishikawa, San-E
A 73-year-old woman was admitted due to weight loss and generalized malaise. The basal levels of all the anterior pituitary hormones, except for prolactin, were reduced. However, they were all elevated in response to exogenous hypothalamic hormones. After starting hydrocortisone replacement, the patient had polyuria of >5,000 mL/day. T1-weighted MRI depicted a low signal of an oval mass in the sella turcica and an iso-intense signal of another mass at the pituitary stalk. These findings indicate a hypothalamic type of hypopituitarism and masked central diabetes insipidus which possibly derived from the atypical occupation of Rathke's cleft cyst at the pituitary stalk.
Birsan, Christina; Raza, Anwar; Cobb, Camilla
A dermoid cyst arising in the parotid is rare and usually represents the rare first branchial cleft type II anomaly, which can have morphology similar to a dermoid cyst. This study reports the case of a 20-year-old woman who presented with a parotid mass, which on histologic review was consistent with a dermoid cyst. This appears to be the first case report of a parotid dermoid cyst with focus on the gross and histopathologic findings and to be presented in a histopathology focused journal. The discussion includes the clinical presentation, imaging findings, gross pathology, histologic features, and differential diagnosis of parotid dermoid cysts. Although there was no prior fine needle aspiration (FNA) of the lesion in this case, parotid masses are commonly subject to FNA prior to excision. Therefore, a brief review of the FNA findings in dermoid cysts is also included.
Chaudhry, Nauman S; Raber, Michael R; Cote, David J; Laws, Edward R
Rathke's cleft cysts (RCC) are benign cystic lesions that originate from remnants of the epithelial lining of Rathke's pouch. RCC are known rarely to occur together with a concomitant pituitary adenoma. Here, we report a patient with a pituitary adenoma arising in the same location as a previously-resected RCC, 3 years post-operatively, and review the literature of "collision" sellar lesions. Consecutive transsphenoidal operations from a single-center between 2008 and 2016 were reviewed to identify patients with pituitary adenoma arising after surgical resection of RCC, and a systematic search of the literature was also performed to identify such patient reports, as well as reports of concomitant pituitary adenoma and RCC. Of 837 transsphenoidal operations from our own experience, one patient with pituitary adenoma occurring after RCC resection was identified and is reported here. A systematic review of the literature resulted in identification of 34 patients with concomitant RCC and pituitary adenoma and no incidents of pituitary adenoma occurring after resection of RCC. Concomitant occurrence of RCC and pituitary adenoma was more commonly diagnosed in women (61%), at a median age of diagnosis of 44 years. The RCC histological analysis in these patients consistently described ciliated columnar or cuboidal epithelium. Although rare, the presence of a new, pathologically-distinct lesions in the sella after prior surgical treatment, is possible. During post-operative monitoring, physicians should consider that what appears as a "recurrent" lesion may actually be growth of a new and entirely different lesion.
Ohnishi, Yu-ichiro; Fujimoto, Yasunori; Iwatsuki, Koichi; Yoshimine, Toshiki
Rathke's cleft cyst (RCC) apoplexy is a rare clinical entity. We report a case of apoplexy of an RCC followed by cerebral infarction. A 67-year-old woman was found lying on the street unconscious. She had fallen from her motorbike. On referral to our hospital she gradually regained consciousness and presented with no neurological deficits. CT showed a round and slightly hyperdense area in the suprasellar region. However, the attending physician did not find this abnormal finding on CT and the patient was discharged the same day. Thirteen days after the first emergency visit she developed left hemiparesis and dysarthria. CT showed a round hypodense area in the suprasellar region. The change of the density in the suprasellar region on CT suggested the pituitary apoplexy. CT also showed a low density area in the territory of the right middle cerebral artery, which indicated the cerebral infarction. MR angiography revealed poor visibility and stenotic changes of right middle cerebral arteries. Transsphenoidal surgery was performed. Histopathological findings confirmed a hemorrhagic RCC. Postoperative MR angiography showed that the visibility and stenosis of right middle cerebral arteries were recovered. This is the rare case of apoplexy of an RCC followed by cerebral infarction. PMID:25810933
Thimsen, Vivian; Hölsken, Annett; Buchfelder, Michael; Flitsch, Jörg; Fahlbusch, Rudolf; Stefanits, Harald; Losa, Marco; Jones, David T W; Buslei, Rolf
The epithelial cell adhesion molecule (EpCAM) is a type I glycoprotein located on the surface of epithelial cells. It is strongly expressed in many neoplasms and already used in the diagnosis and distinction of various tumour subtypes. Comparative studies about EpCAM expression in cystic sellar lesions are lacking. Therefore, we analysed its distribution pattern in adamantinomatous (aCP) and papillary (pCP) craniopharyngiomas (CP) and Rathke's Cleft Cysts (RCC) using immunohistochemistry and gene expression profiling. Whereas the protein was not detectable in pCP (n = 10), all aCP (n = 64) showed distinct staining patterns. The vast majority of RCC (n = 10) also appeared positive, but these displayed notably lower labeling scores. Additionally, significantly higher mRNA levels were detectable in aCP (n = 19) when compared to pCP (n = 10) (p = 9.985(-8)). Furthermore, pediatric aCP cases, in general, exhibited stronger EpCAM staining levels compared to adult ones (p = 0.015). However, we were not able to verify this result on mRNA level. In summary, our findings demonstrate that EpCAM can be used as an additional distinction-marker for cystic lesions of the sellar region. Its unknown function in aCP and the presence of an approved monoclonal bispecific trifunctional antibody for cancer therapy are interesting starting points for further studies.
Peng, Yuping; Fan, Jun; Li, Yu; Qiu, Mingxin; Qi, Songtao
To evaluate the feasibility of the supraorbital keyhole approach for suprasellar or intrasuprasellar Rathke cleft cysts (RCCs) under pure endoscopic visualization. Thirteen surgically treated patients with symptomatic RCCs were analyzed retrospectively. Preoperative manifestations included headache (77%), visual impairment (38%), polyuria (31%), and pituitary dysfunction (15%). The maximal cyst diameter averaged 29.3 mm (23-46 mm). Eight patients (62%) had a purely suprasellar lesion, and 5 (38%) had a sellar lesion with suprasellar extension. All patients underwent surgery via supraorbital keyhole approach under pure endoscopic view. The mean duration of follow-up was 21.4 months (9-45 months). The cyst content was removed completely in all cases, and the cyst wall was resected partially without transgressing surrounding structures. Preoperative headaches, visual dysfunction, diabetes insipidus, and hypopituitarism resolved in 80%, 60%, 50%, and 50% of patients, respectively. Postoperative complications included transient polyuria in 2 cases and temporary subcutaneous fluid collection in one. No radiological recurrence was observed during the follow-up. The supraorbital approach under pure endoscopic visualization provides a valuable optional minimally invasive access for suprasellar and intrasuprasellar RCCs. This approach combines the advantage of minimal invasiveness and improved visualization while avoiding the risk of cerebrospinal fluid leaks, rhinonasal complications, and gland injury. It is particularly suitable for those cysts with the normal pituitary gland occupying the whole or most part of sellar floor. Copyright © 2016 Elsevier Inc. All rights reserved.
Achard, Sophie; Leroy, Xavier; Fayoux, Pierre
Congenital midline cervical cleft is a rare developmental abnormality of the ventral neck of unclear etiology. It consists of a midline skin defect. This study reports a case series of 8 patients with congenital midline cervical cleft. Retrospective review chart including all children referred with congenital midline cervical cleft over 5 years in tertiary center. The study was conducted to determine the presence of associated malformations, to specify the cleft pathology, to analyze the nature of associated cysts, and to discuss surgical procedure. Eight patients ranged from 3 days to 5 years. Two had an associated cervical midline cyst, 3 had a significant micrognatia. Pathological observations were in favor of a branchial origin. There was no recurrence of cervical contraction after a mean follow-up of 20 months. Congenital midline cervical cleft is a rare and generally isolated congenital malformation. It does not require either extensive assessment or specific genetic. Described associated cysts might be part of the cleft and not bronchogenic or thyroglossal cysts. Early surgical excision reduces cervical contracture, but linear or Z-plasty closure is still debated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Ahn, Dongbin; Lee, Gil Joon; Sohn, Jin Ho
Although a retroauricular (RA) approach has been proposed for excision of a second brachial cleft cyst (BCC), no studies have performed a direct comparison of the results of the RA approach and those of the conventional transcervical approach. We evaluated the surgical outcomes of the RA approach under direct vision and demonstrate its benefits compared with the conventional transcervical approach for excision of a second BCC. From January 2012 to May 2016, we enrolled 30 consecutive patients with a second BCC who underwent surgical excision as a primary treatment into the present prospective case-control study. Of the 30 patients, 13 underwent excision of a second BCC with the RA approach and 17 with the conventional transcervical approach. The surgical results, complications, and subjective scar satisfaction scores were estimated and compared between the 2 groups. In all 30 patients, excision of the second BCC was successfully completed under direct vision using the RA or conventional transcervical approach. The mean operating time was significantly less in the conventional group than that in the RA group (68.4 vs 83.4 minutes, respectively; P = .019). No differences were found in the total drainage amount, drainage duration, duration of hospital stay, or postoperative complications between the 2 groups. The mean scar satisfaction score was 6.2 in the conventional group and 8.8 in the RA group, and this difference was statistically significant (P < .001). The RA approach under direct vision for excision of a second BCC is feasible and results in better cosmetic outcomes than the conventional transcervical approach, with no increase in surgical morbidity. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Mlynarek, A; Hagr, A; Tewfik, T L; Nguyen, V H
Congenital Mid-line Cervical Cleft (CMCC) is a rare but interesting congenital anomaly of the neck that is frequently misdiagnosed. Much controversy exist regarding its aetiology. Embryologically, the occurrence of CMCC is thought to be due to many hypotheses that include impaired mid-line fusion of the first or second branchial arches, exteriorisation of a thyroglossal duct remnant, and or increased pressure in the cervical area from the pericardial roof in the developing embryo. Histologically, the cleft usually consists of a stratified keratinized squamous epithelium with hyperkeratosis, dermal fibrosis and little or no skin appendages. Associated clinical features could include thyroglossal duct cysts, cleft lip/mandible/sternum, cervical contractures, mandibular spurs, microgenia and or bronchogenic cysts. In this article we present a patient with CMCC. An extensive review of the literature is also included.
Mendis, D; Moss, A L H
Congenital midline cervical clefts (CMCC) is a clinical diagnosis and represents a spectrum of rare developmental anomalies. Fewer than 100 cases have been reported overall, the first being described by Bailey in 1924 (1). It is not a true cleft because it does not include a gap between adjacent skin flaps. It is thought to represent a failure of midline fusion of the branchial arches although this is controversial. It is a clinical diagnosis and presents at birth with a ventral midline defect of the skin of the neck. This consists of a skin tag (nipple-like projection), an atrophic mucosal surface and a caudal sinus. It may be associated with a subcutaneous fibrous cord, which can cause a vertical midline tethering restricting cervical extension. Associated defects may be a median cleft of the mandible, tongue and lower lip. There may be an associated delay in mandibular development and hypoplasia or absence of neck structures such as the hyoid bone. Associated thyroglossal and bronchogenic cysts may occur as well as defects in other parts of the body such as a sternal cleft (2). CMCC has been previously reported in the literature as being of a branchial origin, however a review of the histology of previous cases suggests a combined branchial and bronchogenic component (2-6). We report on two cases that presented with the clinical picture of a classical CMCC. Our first case appears to have a bronchogenic origin with possible branchial components and the second case appears to be solely branchial in origin. There is much debate as to the embryology of this clinical entity; we shall endeavour to address the main theories.
Kim, Chang-Wook; Hwang, Kihwan; Joo, Jin-Deok; Han, Jung Ho; Kim, Chae-Yong
Background There have been various reports in the literature regarding the conservative management of pituitary apoplexy, pituitary incidentalomas and Rathke cleft cysts (RCCs). However, to the best of our knowledge, spontaneous involution of cystic sellar mass has rarely been reported. We report 14 cases of cystic sellar masses with spontaneous involution. Methods A total of 14 patients with spontaneous regression of cystic sellar masses in our hospital were included. The median age was 35 years (range, 5–67), and 8 patients were male. Clinical symptoms, hormone study and MRI were evaluated for all patients. The initial MRI showed all 14 patients with RCCs. Eight patients were presented with sudden onset of headache, and 1 patient with dizziness. Another patient, a 5-year-old child, was presented with delayed growth. Three patients had no symptoms via regular medical work up. All 14 patients had no visual symptoms. The follow-up period ranged from 5.7 to 42.8 months, with the mean of 17.3 months. Results The mean initial tumor size was 1.29 cm3 (range, 0.05 to 3.23). After involution, the tumor size decreased to 0.23 cm3 (range, 0 to 0.68) without any treatments. Repeated MRI showed a spontaneous decrease in tumor volume by 78% (range, 34 to 99). The initial MRI showed that the tumor was in contact with the optic chiasm in 7 patients, while compressing on the optic chiasm in 3 patients. Five patients were initially treated with hormone replacement therapy due to hormone abnormality. After the follow-up period, only 2 patients needed a long-term hormone replacement therapy. Conclusion The spontaneous involution of RCCs is not well quantified before. Their incidence has not been well demonstrated, but this phenomenon might be underreported. Conservative management can be a treatment option in some RCCs without visual symptoms, even in those that are large in size and in contact with the optic nerve via imaging study. PMID:27867913
Crippa, Beatrice Letizia; Bedeschi, Maria Francesca; Cantarella, Giovanna; Colombo, Lorenzo; Agosti, Viola; Amodeo, Ilaria; Fumagalli, Monica; Mazzola, Isabella; Mosca, Fabio
Numerous malformations can affect the anterior part of the neck presenting at birth as a real diagnostic challenge for the pediatrician or the primary care physician who initially evaluate the baby. Congenital midline cervical cleft represents a rare defect of the midline neck, which is sometimes wrongly diagnosed as a thyroglossal duct anomaly, dermoid cyst, branchial cleft anomaly or "birthmark". A prompt clinical diagnosis and surgical treatment during early infancy are essential to ensure both functional and aesthetic outcome. We report a case of a female neonate with a midline cervical cleft diagnosed immediately after birth. The main features of other congenital anomalies of the anterior neck are also discussed referring to their embryologic origin. © 2014 Japanese Teratology Society.
... However, removal can be challenging because of its location. Dermoid and Epidermoid Cysts: Surgery is typically recommended. If complete removal is not possible, the remaining portion of the cyst may ... American ...
Byun, Sung Hye; Lee, So Young; Hong, Seong Yeon; Ryu, Taeha; Kim, Baek Jin; Jung, Jin Yong
Abstract Introduction: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure. Symptoms and clinical findings: A 28-year-old woman presented with a fetus having a cystic neck mass diagnosed on prenatal ultrasound at 25 weeks of gestation. We planned the EXIT procedure in conjunction with cesarean delivery at 38 weeks of gestation, as the mass enlarged to 4.9 cm × 3.2 cm, protruded externally at the neck, and subsequently resulted in polyhydramnios. Therapeutic intervention and outcomes: After induction of anesthesia using intravenous thiopental (300 mg), adequate uterine relaxation was achieved with sevoflurane (2.0–3.0 vol%) combined with continuous intravenous infusion of nitroglycerin (0.5–1.0 μg/kg/min) for maintaining uteroplacental circulation. After hysterotomy, the head and right upper limb of the fetus were partially delivered, and fetal heart tones were monitored with a sterile Doppler probe. After oropharyngeal suctioning to improve the visual field, the fetus was intubated successfully using a sterile GVL by an anesthesiologist, and the passage of the endotracheal tube beyond the vocal cords was confirmed on the screen of the GVL system. Immediately after the fetal airway was definitely secured, the fetus was fully delivered with umbilical cord clamping. After delivery, nitroglycerine administration was ceased and sevoflurane administration was reduced to 0.5 minimum alveolar concentration. Additionally, oxytocin (10 units) and carbetocin (100 μg) were administered for recovery of uterine contraction. Cesarean delivery was successfully performed without any problems, and the neonate successfully underwent surgery for removal of the neck mass under general anesthesia on the 7th day after delivery. The neonate is developing normally. Conclusion: The GVL approach may be a useful noninvasive approach for establishing a clear fetal airway during the EXIT procedure. PMID:27684833
Hernández-Estrada, Raúl A; Kshettry, Varun R; Vogel, Ashley N; Curtis, Mark T; Evans, James J
Cholesterol granulomas in the sella are rare and can mimic the appearance of craniopharyngioma or Rathke's cleft cysts. Information regarding the clinical presentation, imaging characteristics, and clinical course of sellar cholesterol granulomas can help clinicians to differentiate these lesions from other sellar cystic lesions. We present three cases of sellar cholesterol granulomas. A literature review was performed for all cases of sellar cholesterol granulomas with individual patient data reported. We identified 24 previously reported cases in addition to our three cases. Mean age was 36.6 years (range 5-68). There were 16 (59%) females. The most common (74%) presenting symptom was endocrinological deficits, typically either isolated diabetes insipidus (DI) or panhypopituitarism. Location was intrasellar in 3 (11%), suprasellar in 6 (22%), and intrasellar/suprasellar in 18 (67%) patients. Lesions were most commonly (83%) T1 hyperintense. Gross total resection was achieved in 16 (64%) and subtotal resection in 9 (36%) patients. Of the seventeen (63%) patients presenting with varying degrees of bitemporal hemianopsia, all had improvement in vision postoperatively. It is worth noting that no cases of preoperative hypopituitarism or DI improved postoperatively. Even though gross total resection was only achieved in 64%, there was only one recurrence reported. Sellar cholesterol granulomas are characterized by T1 hyperintensity, younger age, and more frequent and severe endocrinological deficits on presentation. Our review demonstrates high rates of improvement of visual deficits, but poor rates of endocrine function recovery. Recurrence is uncommon even in cases of subtotal resection.
Thimsen, Vivian; Hölsken, Annett; Buchfelder, Michael; Flitsch, Jörg; Fahlbusch, Rudolf; Stefanits, Harald; Losa, Marco; Jones, David T. W.; Buslei, Rolf
The epithelial cell adhesion molecule (EpCAM) is a type I glycoprotein located on the surface of epithelial cells. It is strongly expressed in many neoplasms and already used in the diagnosis and distinction of various tumour subtypes. Comparative studies about EpCAM expression in cystic sellar lesions are lacking. Therefore, we analysed its distribution pattern in adamantinomatous (aCP) and papillary (pCP) craniopharyngiomas (CP) and Rathke’s Cleft Cysts (RCC) using immunohistochemistry and gene expression profiling. Whereas the protein was not detectable in pCP (n = 10), all aCP (n = 64) showed distinct staining patterns. The vast majority of RCC (n = 10) also appeared positive, but these displayed notably lower labeling scores. Additionally, significantly higher mRNA levels were detectable in aCP (n = 19) when compared to pCP (n = 10) (p = 9.985−8). Furthermore, pediatric aCP cases, in general, exhibited stronger EpCAM staining levels compared to adult ones (p = 0.015). However, we were not able to verify this result on mRNA level. In summary, our findings demonstrate that EpCAM can be used as an additional distinction-marker for cystic lesions of the sellar region. Its unknown function in aCP and the presence of an approved monoclonal bispecific trifunctional antibody for cancer therapy are interesting starting points for further studies. PMID:27431859
... parasites, such as some types of roundworms and tapeworms, can form cysts within the muscles, liver, brain, ... King CH, Fairley JK. Tapeworms (cestodes). In: Bennett JE, Dolin R, ... Principles and Practice of Infectious Diseases, Updated ...
Srbecka, Kristyna; Michalova, Kvetoslava; Curcikova, Radmila; Michal, Michael; Dubova, Magdalena; Svajdler, Marian; Michal, Michal; Daum, Ondrej
There is a group of lesions in the head and neck region derived from branchial arches and related structures which, when inflamed, are characterized by the formation of cysts lined by squamous or glandular epithelium and surrounded by a heavy inflammatory infiltrate rich in germinal centers. In the thyroid, the main source of various structures which may cause diagnostic dilemma is the ultimobranchial body. To investigate the spectrum of such thyroid lesions, the consultation files were reviewed for thyroid samples containing pathological structures regarded to arise from the ultimobranchial body. Positive reaction with antibodies against CK5/6, p63, galectin 3, and CEA, and negative reaction with antibodies against thyroglobulin, TTF-1, and calcitonin were used to confirm the diagnosis. The specific subtype of the ultimobranchial body-derived lesion was then determined based on histological examination of H&E-stained slides. Twenty-one cases of ultimobranchial body-derived lesions were retrieved from the consultation files, 20 of them along with clinical information (M/F = 6/14, mean age 55 years, range 36-68 years). Lesions derived from the ultimobranchial body were classified as follows: (hyperplastic) solid cell nests (nine cases), solid cell nests with focal cystic change (five cases), cystic solid cell nests (two cases), branchial cleft-like cyst (four cases), and finally a peculiar Warthin tumor-like lesion (one case). We suggest that the common denominator of these structures is that they all arise due to activation of inflammatory cells around the vestigial structures, which leads to cystic dilatation and proliferation of the epithelial component.
Liberman, Moishe; Kay, Saundra; Emil, Sherif; Flageole, Hélène; Nguyen, Luong T; Tewfik, Ted L; Oudjhane, Kamal; Laberge, Jean-Martin
Third and fourth branchial remnants may result in cysts and abscesses that are in close contact with the thyroid gland. These anomalies are rare and often present diagnostic and therapeutic challenges. The charts of patients diagnosed with a branchial anomaly between July 1991 and July 2001 at the Montreal Children's Hospital were reviewed. All cases of third and fourth branchial remnants or pyriform sinus fistulae were identified. Clinical presentation, imaging, treatment, and outcome were recorded. Eight patients with a third or fourth branchial anomaly were identified and ranged in age from birth to 13 years. All anomalies were left sided. Presenting symptoms consisted of an asymptomatic cervical mass (n = 1), an infected mass (n = 5), neonatal respiratory distress (n = 1), and 1 incidental cyst found on magnetic resonance imaging. Ultrasonography was useful in suggesting the diagnosis in 7 cases. Barium swallow was performed in 3 patients with 2 positive results. Pharyngoscopy results showed the internal opening in 2 of 7 patients. A portion of the thyroid gland was resected in 6 patients. One patient has not yet undergone a definitive procedure. There was 1 recurrence in a patient whose pathology did not confirm a branchial remnant. The diagnosis and management of pyriform sinus anomalies are challenging. Ultrasound scan, computed tomography scan, barium swallow, and pharyngoscopy are all useful. The portion of thyroid involved in the fistula must be excised en bloc with the inflammatory mass, and the tract should be ligated at the level of the pharynx to minimize recurrence. Copyright 2002, Elsevier Science (USA). All rights reserved.
Agag, Richard; Sacks, Justin; Silver, Lester
Congenital midline cervical cleft (CMCC) is a rare disorder of the ventral neck that is clinically evident at birth and must be differentiated from the more common thyroglossal duct cyst. The case of CMCC presented here was associated with chromosomes 13/14 de novo Robertsonian translocations as well as midline deformities including a sacral tuft and a minor tongue-tie. The case is presented as well as discussion of histopathology, embryology, and surgical treatment.
... side. There are three primary types of clefts: Cleft lip/palate refers to the condition when both the palate ... one in 1,000 babies are born with cleft lip/palate. About 50 percent of all clefts More common ...
... is done in a hospital under general anesthesia. Pre- and post-surgical evaluation by members of a ... prosthodontist) associated with a cleft palate team. Again, pre- and post-treatment evaluation by the cleft palate ...
James, Adrian; Stewart, Craig; Warrick, Paul; Tzifa, Constance; Forte, Vito
The objective of this study was to review clinical and embryologic aspects of third and fourth branchial anomalies. Retrospective study. We reviewed the institutional and departmental databases at our institution to identify all cases of third and fourth branchial anomalies encountered from 1992 to 2006. All patient records were examined with respect to demographics, clinical history, and radiologic and pathologic reports. We identified 17 cases of third and fourth branchial anomalies, the largest series of its kind reported to date. The lesions were predominantly left sided, all presenting with neck infection. Fistula formation was iatrogenic, secondary to incision and drainage. Preoperative direct laryngoscopy always revealed a pit within the apex of the piriform fossa. Surgical excision involved ipsilateral thyroidectomy as the lesion passed through the thyroid gland. No lesions following the classical course of a either a third or fourth branchial anomaly were identified. The clinical presentation of branchial sinuses arising from the piriform fossa is more in keeping with derivation from the thymopharyngeal duct (of the third pouch) than the hypothetical course of third and fourth branchial fistulae.
... and advocacy priorities National Network of Perinatal Quality Collaboratives Launch Prematurity research centers What is team science? ... how the body develops or how the body works. Cleft lip and cleft palate are common birth ...
Avior, Galit; Derowe, Ari; Fliss, Dan M; Leicear-Trejo, Leonor; Braverman, Itzhak
The cat eye syndrome is a congenital malformation usually associated with anal atresia, ocular coloboma, downward slanting eyes, microphthalmia, hypertelorism, strabismus, preauricular tags or fistulas, congenital heart defect particularly septal defect, urinary tract abnormalities, skeletal anomalies and frequently mental and physical retardation. A small supernumerary chromosome (smaller than chromosome 21) is present, frequently has 2 centromeres, is bisatellited and represents an inv dup 22 (q11). A two years old female presented to our department with an association of cat eye syndrome with preauricular tags and a first branchial arch anomaly. This article discusses the surgical management and the association between the cat eye syndrome and first branchial cleft anomaly.
Patel, Jasminkumar Bharatbhai; Kilbride, Howard; Paulson, Lorien
Branchial cleft cysts are common causes of congenital neck masses in the pediatric population. However, neonatal presentation of branchial cleft cysts is uncommon, but recognizable secondary to acute respiratory distress from airway compression or complications secondary to infection. We report a 1-day-old infant presenting with an air-filled neck mass that enlarged with Valsalva and was not associated with respiratory distress. The infant was found to have a third branchial cleft cyst with an internal opening into the pyriform sinus. The cyst was conservatively managed with endoscopic surgical decompression and cauterization of the tract and opening. We review the embryology of branchial cleft cysts and current management. PMID:26495186
... ovarian cysts develop as a result of your menstrual cycle (functional cysts). Other types of cysts are much ... cysts: Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and ...
Rosenfeld, R M; Biller, H F
The fourth branchial pouch sinus (FBPS) is a rare translaryngeal anomaly with diverse manifestations, including neonatal stridor and recurrent deep neck infection. Review of the world literature reveals 23 reports of sinuses consistent with fourth pouch origin. We present two additional cases, including the only example of a right-sided FBPS. Retrograde excision, beginning at the piriform apex, ensures complete removal of the tract and protection of the recurrent nerve. The posterior border of the thyroid ala must be resected or retracted for adequate exposure. Failure to remove the translaryngeal portion of the tract almost guarantees recurrence.
... or cleft palate. A cleft lip is a separation of the two sides of the lip. The separation often includes the bones of the upper jaw ... 5 Comments Miracle Flights Puts Care in the Air 11/20/15 , No Comments Connections to be ...
... If teasing or self-esteem issues arise at school, this can help your child feel safe in talking with you about it. After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and ...
Panakkool-Thamban, Aneesh; Ameri Kottarathil, Helna; Kappalli, Sudha
Occurrence of cymothoid isopods parasitizing the branchial chamber of marine food fishes along the Malabar coast was investigated. Live and fresh fishes collected from the Ayyikkara fish landing center (Lat. 11°51'N, Long. 75°22'E; Malabar coast, India) were subjected to the thorough observation for the presence of branchial cymothoids for 3 consecutive years (November 2009-November 2012). Among the recovered cymothoids, 11 species were branchial residents belonging to 6 genera; the species include Agarna malayi, Catoessa gruneri, C. boscii, Joryma hilsae, J. brachysoma, J. engraulidis, J. sawayah, Mothocya collettei, M. renardi, Norileca indica and Ryukyua circularis; highest prevalence being exhibited by two species of Mothocya, (M. renardi and M. collettei) parasitizing the belonidaen fishes, Strongylura leiura (92.15 %) and Tylosurus crocodilus crocodilus (87.2 %) respectively. Except Mothocya species, which preferred the branchial floor for infestation, all recovered branchial cymothoids were found attached the inner wall of the operculum. In several instances, the parasites appeared in male-female pairs, one in each branchial cavity. Ovigerous female members of all species of branchial cymothoids except R. circularis showed remarkable bending either towards left or right depending on whether they are located in right or left branchial cavity of their respective host fishes. The deleterious effects of parasitization by all recovered branchial cymothoids include the formation of a pit like depression in the branchial chamber and atrophy of the gill filament; the damage was more pronounced in the gill cavity of parasitized host fishes where the ovigerous female member was accommodated.
Su, Yukai; Ishii, Yudo; Lin, Chien-Min; Tahara, Shigeyuki; Teramoto, Akira; Morita, Akio
Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach. PMID:25685785
Trandafir, Violeta; Trandafir, Daniela; Ferariu, D; Boişteanu, Otilia; Haba, Danisia
Dermoid cyst of the parotid gland is a rare clinical entity. Definitive clinical diagnosis is often difficult to determine preoperatively because of the lack of pathognomonic features. The most frequent location of a parotid dermoid cyst is a triangular area lying above the pinna. Imaging studies do not definitely diagnose a parotid dermoid cyst. Although parotid dermoid cyst is (generally) well-encapsulated, complete removal of the cyst wall is not sufficient to cure it, so it is mandatory to perform careful excision of the cyst by parotidectomy, in terms of preserving facial nerve integrity. Histopathology of the parotid gland tumor removed by parotidectomy makes a diagnosis of certainty, by revealing a cyst wall with keratinization of the squamous epithelium and the presence of skin annexes (hair follicles, sweat glands, sebaceous glands). We present a rare case of parotid dermoid cyst in a 21-year-old male patient with symptoms and imaging rather suggestive of arch I branchial cyst and a brief review of data in the medical literature of the last 20 years.
Ortube, Maria Carolina; Dipple, Katrina; Setoguchi, Yoshio; Kawamoto, Henry K.; Demer, Joseph L.
Introduction In the Tessier classification, craniofacial clefts are numbered from 0 to 14 and extend along constant axes through the eyebrows, eyelids, maxilla, nostrils, and the lips. We studied a patient with bilateral cleft 10 associated with ocular abnormalities. Method Clinical report with orbital and cranial computed tomography. Results After pregnancy complicated by oligohydramnios, digoxin, and lisinopril exposure, a boy was born with facial and ocular dysmorphism. Examination at age 26 months showed bilateral epibulbar dermoids, covering half the corneal surface, and unilateral morning glory anomaly of the optic nerve. Ductions of the right eye were normal, but the left eye had severely impaired ductions in all directions, left hypotropia, and esotropia. Under anesthesia, the left eye could not be rotated freely in any direction. Bilateral Tessier cleft number 10 was implicated by the presence of colobomata of the middle third of the upper eyelids and eyebrows. As the cleft continued into the hairline, there was marked anterior scalp alopecia. Computed x-ray tomography showed a left middle cranial fossa arachnoid cyst and calcification of the reflected tendon of the superior oblique muscle, trochlea, and underlying sclera, with downward and lateral globe displacement. Discussion Tessier 10 clefts are very rare and usually associated with encephalocele. Bilateral 10 clefts have not been reported previously. In this case, there was coexisting unilateral morning glory anomaly and arachnoid cyst of the left middle cranial fossa but no encephalocele. Conclusions Bilateral Tessier facial cleft 10 may be associated with alopecia, morning glory anomaly, epibulbar dermoids, arachnoid cyst, and restrictive strabismus. PMID:20856062
... is about cysts that form during your monthly menstrual cycle, called functional cysts. Functional cysts are not the ... or other diseases. Causes Each month during your menstrual cycle, a follicle grows on your ovary. The follicle ...
Demange, Marco Kawamura
Baker's cysts are located in the posteromedial region of the knee between the medial belly of the gastrocnemius muscle and semimembranosus tendon. In adults, these cysts are related to intra-articular lesions, which may consist of meniscal lesions or arthrosis. In children, these cysts are usually found on physical examination or imaging studies, and they generally do not have any clinical relevance. Ultrasound examination is appropriate for identifying and measuring the popliteal cyst. The main treatment approach should focus on the joint lesions, and in most cases there is no need to address the cyst directly. Although almost all knee cysts are benign (Baker's cysts and parameniscal cysts), presence of some signs makes it necessary to suspect malignancy: symptoms disproportionate to the size of the cyst, absence of joint damage (e.g. meniscal tears) that might explain the existence of the cyst, unusual cyst topography, bone erosion, cyst size greater than 5 cm and tissue invasion (joint capsule). PMID:27027065
... a result of the normal function of your menstrual cycle. These are known as functional cysts. Other types ... cysts: Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and ...
Strychowsky, Julie E; Rahbar, Reza
Laryngotracheoesophageal clefts are rare congenital anomalies of the aerodigestive tract. Patients may present with airway and/or swallowing impairments. An approach to evaluation and management is presented. Important pearls for conservative and surgical management are discussed. Open versus endoscopic surgical techniques are reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.
Resources - cleft palate ... The following organizations are good resources for information on cleft palate : Cleft Palate Foundation -- www.cleftline.org March of Dimes -- www.marchofdimes.com/professionals/14332_1210.asp ...
Guttikonda, Leela Krishna; Nadella, Koteswara Rao; Uppaluru, Vijayalakshmi; Kodali, Rama Mohan; Nallamothu, Ranganadh
Median cleft of lower lip and mandible is a rare congenital anomaly described as cleft number 30 of Tessier's classification. In minor forms only lower lip cleft is seen. We report the case of a patient with median cleft of lower lip, severe ankyloglossia, cleft of mandibular symphysis, and residual cleft involving on right soft palate and associated with other facial clefts. These deformities were corrected in multiple stage procedure, consisting of release of the tongue from floor of the mouth and lower alveolus and fixation of the mandibular cleft done with right iliac bone graft using stainless steel miniplate. PMID:24711928
Jayasuriya, Nadeena Sri Swarnagupta; Siriwardena, Samadarani; Tilakaratne, Wanninayake Mudiyanselage; Parthiepan, Suchithra
Submental dermoid cysts are uncommon midline cysts which occur due to entrapment of ectoderm between the second and third branchial arches during embryogenesis. Most dermoid cysts of the head and neck are benign, but rarely malignant transformation may occur. To the best of our knowledge, this is the first report of a carcinosarcoma arising in a submental dermoid cyst. A 42-year-old Sri Lankan Tamil man presented with a large cystic swelling in his submental region which was diagnosed as an extensive submental dermoid cyst. The cyst had been asymptomatic for 11 years but there was sudden enlargement and pain during the past 2 months. On surgical removal, a primary carcinosarcoma arising from part of the cyst wall was identified. After completion of radiotherapy, the disease was well controlled and he was disease free at 18 months. Although extremely rare, a dermoid cyst of the submental region can undergo malignant transformation. It can be successfully treated with surgical excision and radiotherapy.
The branchial elimination of pentachloroethane and four congeneric polychlorinated bephenyls by rainbow trout was measured using a fish respirometer-metabolism chamber and an adsorption resin column. Branchial elimination was characterized by calculating a set of apparent in vivo...
Development of PBTK models for fish has been impededd by a lack of data on the branchial elimination of hydrophobic compounds. The hypothesis is that branchial efflux of high log Kow compounds proceeds to an equilibrium between the afferent blood and expired water. Branchial effl...
Bhattacharyya, Nirmal C.; Kalita, Kabita; Gogoi, Manoj; Deuri, Pradip K.
A case of midline cleft of the lower lip with cleft of the mandible and complete duplication of the tongue is reported here. Median cleft of the lower lip, mandible and bifid tongue with ankyloglossia is reported in the literature, but complete duplication of the tongue as part of the Tessier 30 cleft is not yet reported. PMID:22529554
... all the way to the back of your mouth. What's a Cleft Lip or Cleft Palate? The word cleft means a gap or split between two things. A cleft lip is a split in the upper lip. This can happen on one or ... a split in the roof of the mouth. This leaves a hole between the nose and ...
Lauwers, H; Capoen, J; De Baets, F; Azou, M
The authors report a rare case of gastroenteric cyst in a 4-day-old baby with increasing cyanosis. CT and MRI demonstrated a posterior mediastinal cystic mass, which finally was characterised by pathology as a gastroenteric cyst.
... ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI) scans. Sometimes kidney cysts are found when one of ... might want you to have a CT or MRI scan of your kidney to see if the cyst ...
Wang, Xia; Xu, Yaosheng
Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.
... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...
Horvath, Gabriella A; Armstrong, Linlea
In 1998, Hisama et al. described three brothers born following pregnancies complicated by oligohydramnios in the second or third trimester. Post-natal renal functions were compromised, and post-mortem studies showed kidney tissue abnormalities. Resuscitation and support were required, and they survived 25 hr to 12 days. All boys had a similar craniofacial appearance with infraorbital creases, low set dysplastic ears, as well as athelia, and broad digits with small nails. Variably present features were choanal atresia, preauricular tags and pits, branchial clefts, ventricular septal defect, type IIB interrupted aortic arch, pulmonary lobation anomaly, absent gallbladder, absent thymus, absent parathyroid gland, accessory spleen, and imperforate anus. Their mother, maternal grandmother, and maternal first cousin had neck cysts removed as children. We describe a female infant born following a pregnancy where oligohydramnios developed between 27 and 33 weeks gestation. Renal function was initially impaired, but improved over the first weeks of life. There was however a persistent renal wasting of magnesium. Her craniofacial appearance with infraorbital creases and low set dysplastic ears was similar to the brothers' described by Hisama et al. [1998; Am J Med Genet 80:335-342]. She had choanal atresia, athelia, a preauricular pit, gingival cysts, broad digits with small nails, right aortic arch with a vascular ring, hypothyroidism, impaired glucose homeostasis, hypoadrenalism, neurological impairment, and brain calcifications on CT. She died after 13 weeks of intensive care. Her mother as a child and maternal grandfather as an adult had neck cysts removed. The similarities between the cases suggest a common syndrome.
Wood, Chris M.
All teleost fish produce ammonia as a metabolic waste product. In embryos, ammonia excretion is limited by the chorion, and fish must detoxify ammonia by synthesizing urea via the ornithine urea cycle (OUC). Although urea is produced by embryos and larvae, urea excretion (Jurea) is typically low until yolk sac absorption, increasing thereafter. The aim of this study was to determine the physiological and molecular characteristics of Jurea by posthatch rainbow trout (Oncorhynchus mykiss). Following hatch, whole body urea concentration decreased over time, while Jurea increased following yolk sac absorption. From 12 to 40 days posthatch (dph), extra-branchial routes of excretion accounted for the majority of Jurea, while the gills became the dominant site for Jurea only after 55 dph. This represents the most delayed branchial ontogeny of any process studied to date. Urea transporter (UT) gene expression in the gills and skin increased over development, consistent with increases in branchial and extra-branchial Jurea. Following exposure to 25 mmol/l urea, the accumulation and subsequent elimination of exogenous urea was much greater at 55 dph than 12 dph, consistent with increased UT expression. Notably, UT gene expression in the gills of 55 dph larvae increased in response to high urea. In summary, there is a clear increase in urea transport capacity over posthatch development, despite a decrease in OUC activity. PMID:26608657
Zimmer, Alex M; Wood, Chris M
All teleost fish produce ammonia as a metabolic waste product. In embryos, ammonia excretion is limited by the chorion, and fish must detoxify ammonia by synthesizing urea via the ornithine urea cycle (OUC). Although urea is produced by embryos and larvae, urea excretion (J(urea)) is typically low until yolk sac absorption, increasing thereafter. The aim of this study was to determine the physiological and molecular characteristics of J(urea) by posthatch rainbow trout (Oncorhynchus mykiss). Following hatch, whole body urea concentration decreased over time, while J(urea) increased following yolk sac absorption. From 12 to 40 days posthatch (dph), extra-branchial routes of excretion accounted for the majority of J(urea), while the gills became the dominant site for J(urea) only after 55 dph. This represents the most delayed branchial ontogeny of any process studied to date. Urea transporter (UT) gene expression in the gills and skin increased over development, consistent with increases in branchial and extra-branchial J(urea). Following exposure to 25 mmol/l urea, the accumulation and subsequent elimination of exogenous urea was much greater at 55 dph than 12 dph, consistent with increased UT expression. Notably, UT gene expression in the gills of 55 dph larvae increased in response to high urea. In summary, there is a clear increase in urea transport capacity over posthatch development, despite a decrease in OUC activity. Copyright © 2016 the American Physiological Society.
Nasolabial cyst is a rare nonodontogenics, soft-tissue cyst occurring in the sublabial area and anterior maxillary region. The patient usually presents with a slowly enlarging asymptomatic swelling. They are usually diagnosed in early stages because of cosmetic problems. In our paper we report a nasolabial cyst of a 53-year-old man and discuss the diagnosis, differential diagnosis, and treatment in the light of the literature.
Lu, Wu-Hao; Feng, Long; Sang, Jian-Zhong; Wang, Liang; Yuan, Lin-Lin; Gao, Ling; Lou, Wei-Hua
A recurrent neck abscess or acute suppurative thyroiditis should arouse suspicion of fourth branchial pouch sinus. Complete surgical excision is usually curative. The classification of sinus tract according to the area where it is emerging from the larynx may be helpful in identifying the tract during surgery. To describe our experience of the diagnosis and management of fourth branchial pouch sinus and elucidate three different emerging pathways of the sinus tract during surgery. Retrospective case series with eight patients who were diagnosed with fourth branchial pouch sinus between January 2007 and July 2011 at the First Affiliated Hospital of Zhengzhou University. Six patients presented with recurrent neck abscess, two presented with acute suppurative thyroiditis. All patients had barium swallow and sinus tract was delineated in six cases. All eight patients underwent surgical excision of the sinus tract. Three different emerging pathways of the sinus tract were identified during surgery. The tract could penetrate the thyroid cartilage near the inferior horn, the inferior pharyngeal constrictor muscle or the cricothyroid membrane when it emerged from the larynx. The recurrent laryngeal nerve was commonly dissected to avoid inadvertent damage. Hemithyroidectomy was performed in six patients. All eight are currently asymptomatic.
Konno, Alu; Shiba, Kogiku; Cai, Chunhua; Inaba, Kazuo
Eukaryotic cilia and flagella have highly conserved 9 + 2 structures. They are functionally diverged to play cell-type-specific roles even in a multicellular organism. Although their structural components are therefore believed to be common, few studies have investigated the molecular diversity of the protein components of the cilia and flagella in a single organism. Here we carried out a proteomic analysis and compared protein components between branchial cilia and sperm flagella in a marine invertebrate chordate, Ciona intestinalis. Distinct feature of protein recruitment in branchial cilia and sperm flagella has been clarified; (1) Isoforms of α- and β-tubulins as well as those of actins are distinctly used in branchial cilia or sperm flagella. (2) Structural components, such as dynein docking complex, tektins and an outer dense fiber protein, are used differently by the cilia and flagella. (3) Sperm flagella are specialized for the cAMP- and Ca2+-dependent regulation of outer arm dynein and for energy metabolism by glycolytic enzymes. Our present study clearly demonstrates that flagellar or ciliary proteins are properly recruited according to their function and stability, despite their apparent structural resemblance and conservation. PMID:25962172
Crockett, David J; Goudy, Steven L
Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck. Orofacial clefting could significantly affect the quality of life of the child and requires multiple steps of care to obtain an optimal outcome. Each patient should be evaluated for congenital anomalies, developmental delay, neurologic disorders, and psychosocial concerns. A multidisciplinary team is necessary to ensure that every aspect of the child's care is appropriately treated and coordination between providers is achieved. This article discusses the assessment and treatment recommendations for children born with cleft lip and/or cleft palate. Copyright © 2014 Elsevier Inc. All rights reserved.
... You may need a biopsy to rule out vaginal cancer, especially if the mass appears to be solid. If the cyst is located under the bladder or urethra, x-rays may be needed to see if the cyst extends into these organs.
Stark, Richard B., Ed.
Nineteen articles present a multidisciplinary approach to the management of facial clefts. The following subjects are discussed: the history of cleft lip and cleft palate surgery; cogenital defects; classification; the operation of a cleft palate clinic; physical examination of newborns with cleft lip and/or palate; nursing care; anesthesia;…
Stark, Richard B., Ed.
Nineteen articles present a multidisciplinary approach to the management of facial clefts. The following subjects are discussed: the history of cleft lip and cleft palate surgery; cogenital defects; classification; the operation of a cleft palate clinic; physical examination of newborns with cleft lip and/or palate; nursing care; anesthesia;…
Huis, Marijan; Balija, Milivoj; Lez, Cvjetko; Szerda, Ferenc; Stulhofer, Mladen
Mesenteric cysts and cystic mesenteric tumors are very rare abdominal growths. They may be localized all over the mesentery, from duodenum to rectum, however, they are mostly found in the ileum and right colon mesentery. There are several classifications of these formations, among which the one based on histopathologic features including 6 groups has been most commonly used: 1) cysts of lymphatic origin--lymphatic (hilar cysts) and lymphangiomas; 2) cysts of mesothelial origin--benign or malignant mesothelial cysts; 3) enteric cysts; 4) cysts of urogenital origin; 5) dermoid cysts; and 6) pseudocysts--infectious or traumatic etiology. Two adult female patients treated at the Department of Surgery, Zabok General Hospital, are presented. The diagnosis of mesenteric cyst was based on explorative laparotomy indicated for a cystic abdominal growth and characteristic palpatory finding, US and CT findings. In both patients, the cysts were successfully treated by total cystectomy. Pathohistologic findings pointed to lymphatic cysts. Control US finding at 3 months postoperatively was normal in both patients. Cystic lymphangioma mostly occurs in the first decade of life, with a female predominance. It is usually accompanied by acute abdominal symptomatology. Lymphatic cysts occur later in life (1:100,000 in adults and 1:20,000 in children), also show female predominance, and as a rule are asymptomatic. A mesenteric cyst, especially lymphatic, should be suspected in the presence of painless abdominal tumor, with occasionally painful abdominal pressure, normal laboratory findings, and good general condition in a female patient. In symptomatic cases, acute or chronic abdominal pain is the most common feature, whereas other symptomatology depends on the localization, size and consequential abdominal organ compression (intestinal obstruction, hydronephrosis, lower extremity lymphedema). The term of cystic mesenteric tumor is mostly used to refer to cystic lymphangiomas and
McInnes, Colin W; Benson, Alex D; Verchere, Cynthia G; Ludemann, Jeffrey P; Arneja, Jugpal S
Congenital midline cervical cleft (CMCC) is a rare developmental defect of the anterior neck normally characterized by an atrophic mucosal plaque with a cranial nipple-like skin tag, a short caudal sinus, and may be attached to a subcutaneous fibrous cord of variable length. Clinically, patients present at an early age with, white females being the most commonly affected population. In addition to aesthetic concerns, CMCC can prevent full extension of the neck, result in micrognathia and torticollis, predispose patients to infection, and can coexist with other clefting defects or cysts. Fewer than 50 cases have been published in the English-language literature. Herein, we report a case of CMCC that also presented with a mild contracture of the right sternohyoid muscle. The embryopathogenesis, histopathology, diagnosis, and treatment of this rare condition are also discussed.
... bacteria that cause sexually transmitted infections such as gonorrhea and chlamydia. A Bartholin's cyst or abscess may recur and again require treatment. Your first appointment will likely be with either ...
... ll discuss your symptoms, their relation to your menstrual cycle and any other relevant information. To prepare for ... in one or both breasts? How does your menstrual cycle affect the breast cyst or lump? When was ...
... triggering pancreatitis, you may need to have your gallbladder removed. If your pancreatitis is due to alcohol ... www.mayoclinic.org/diseases-conditions/pancreatic-cysts/basics/definition/CON-20024331 . Mayo Clinic Footer Legal Conditions and ...
... common type of PKD end up with kidney failure. PKD also causes cysts in other parts of ... and lifestyle changes, and if there is kidney failure, dialysis or kidney transplants. Acquired cystic kidney disease ( ...
Sanchis, J M; Peñarrocha, M; Bagan, J V; Guarinos, J; Vera, F
The incidence of radicular cysts in 125 chronic periapical lesions was studied in 36 cases of periapical surgery (28.8%), and to 89 tooth extractions (71.2%). Histopathology revealed 18 radicular cysts (14.4%) and 107 lesions corresponding to chronic apical periodontitis (C.A.P.) or granulomas (85.6%). Cholesterol clefts, a fibrous capsule and presence of a cavity were more common in the cysts, significant differences being observed with respect to chronic apical periodontitis.
Biswas, G; Khandelwal, N K; Venkatramu, N K; Chari, P S
A cleft of the sternum is a rare congenital anomaly. We present a case of a sternal cleft in a 7-year-old boy. A split iliac bone graft covered with the sternocostal portion of a pectoralis major flap was used to reconstruct the defect. Copyright 2001 The British Association of Plastic Surgeons.
Ellis, Nicholas A; Miller, Craig T
The posterior pharyngeal segments of the vertebrate head give rise to the branchial skeleton, the primary site of food processing in fish. The morphology of the fish branchial skeleton is matched to a species' diet. Threespine stickleback fish (Gasterosteus aculeatus) have emerged as a model system to study the genetic and developmental basis of evolved differences in a variety of traits. Marine populations of sticklebacks have repeatedly colonized countless new freshwater lakes and creeks. Adaptation to the new diet in these freshwater environments likely underlies a series of craniofacial changes that have evolved repeatedly in independently derived freshwater populations. These include three major patterning changes to the branchial skeleton: reductions in the number and length of gill raker bones, increases in pharyngeal tooth number, and increased branchial bone lengths. Here we describe a detailed protocol to dissect and flat-mount the internal branchial skeleton in threespine stickleback fish. Dissection of the entire three-dimensional branchial skeleton and mounting it flat into a largely two-dimensional prep allows for the easy visualization and quantification of branchial skeleton morphology. This dissection method is inexpensive, fast, relatively easy, and applicable to a wide variety of fish species. In sticklebacks, this efficient method allows the quantification of skeletal morphology in genetic crosses to map genomic regions controlling craniofacial patterning.
Ellis, Nicholas A.
SHORT ABSTRACT The branchial skeleton, including gill rakers, pharyngeal teeth, and branchial bones, serves as the primary site of food processing in most fish. Here we describe a protocol to dissect and flat-mount this internal skeleton in threespine sticklebacks. This method is also applicable to a variety of other fish species. LONG ABSTRACT The posterior pharyngeal segments of the vertebrate head give rise to the branchial skeleton, the primary site of food processing in fish. The morphology of the fish branchial skeleton is matched to a species’ diet. Threespine stickleback fish (Gasterosteus aculeatus) have emerged as a model system to study the genetic and developmental basis of evolved differences in a variety of traits. Marine populations of sticklebacks have repeatedly colonized countless new freshwater lakes and creeks. Adaptation to the new diet in these freshwater environments likely underlies a series of craniofacial changes that have evolved repeatedly in independently derived freshwater populations. These include three major patterning changes to the branchial skeleton: reductions in the number and length of gill raker bones, increases in pharyngeal tooth number, and increased branchial bone lengths. Here we describe a detailed protocol to dissect and flat-mount the internal branchial skeleton in threespine stickleback fish. Dissection of the entire three-dimensional branchial skeleton and mounting it flat into a largely two-dimensional prep allows for the easy visualization and quantification of branchial skeleton morphology. This dissection method is inexpensive, fast, relatively easy, and applicable to a wide variety of fish species. In sticklebacks, this efficient method allows the quantification of skeletal morphology in genetic crosses to map genomic regions controlling craniofacial patterning. PMID:27213248
Hirokawa, Shinichiro; Uotani, Hideyuki; Okami, Hideo; Tsukada, Kazuhiro; Futatani, Takeshi; Hashimoto, Ikuo
A congenital midline cervical cleft (CMCC) is a rare developmental anomaly. It may represent failure of the branchial arches to fuse in the midline and presents at birth with a ventral midline defect of the skin of the neck. Congenital heart disease along with CMCC is rarer, and most of the cases reported are associated with chest wall defects or thoracic ectopia cordis. The authors report a case of a 5-month-old girl with CMCC and an atrial septal defect (ASD) and discuss the clinical presentation, embryologic development, and treatment.
Farhadi, Roya; Sahebpour, Alireza Alam; Ghasemi, Maryam
Congenital midline cervical cleft (CMCC) is a rare developmental anomaly of the anterior neck, mostly found in Caucasian females. Most authors consider it within the spectrum of branchial arch developmental abnormalities. There have been about 100 reported cases in the literature. However, there is no agreement on the age of surgery in this anomaly. In this report we present our experience of managing this anomaly in the early neonatal period in two neonates. One of them had concomitantly congenital heart disease. It is important to recognize this rare congenital anomaly in neonate. Although the exact time of surgery for CMCC is not mentioned, based on our results the earliest time of intervention is recommended since then the operating result will be excellent.
Farhadi, Roya; Sahebpour, Alireza Alam; Ghasemi, Maryam
Background Congenital midline cervical cleft (CMCC) is a rare developmental anomaly of the anterior neck, mostly found in Caucasian females. Most authors consider it within the spectrum of branchial arch developmental abnormalities. There have been about 100 reported cases in the literature. However, there is no agreement on the age of surgery in this anomaly. Case Presentation In this report we present our experience of managing this anomaly in the early neonatal period in two neonates. One of them had concomitantly congenital heart disease. Conclusion It is important to recognize this rare congenital anomaly in neonate. Although the exact time of surgery for CMCC is not mentioned, based on our results the earliest time of intervention is recommended since then the operating result will be excellent. PMID:23431110
... Treatment should only be done by your provider. Oral surgeons and some dentists can remove the sac. Possible Complications Complications may include: Return of the ... your provider if you: Notice a cyst or mass in your mouth Have difficulty swallowing or talking These may be ...
Sivaraman, L.; Sivasubramanian, S. V.
The classification, clinical features, and treatment of prostatic cysts are discussed with reference to 2 personal cases which differed in origin, in mode of presentation, and in the management required. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:718076
Wang, Qinying; Chen, Haihong; Wang, Shenqing
Objectives: To determine the outcomes of coblation assisted transnasal endoscopic resection of nasopharyngeal cyst. Method: Retrospective chart review outcomes in 12 patients who underwent endoscopic resect cysts of the nasopharynx at our department between 2001 and 2010. Twelve patient, aged 28 to 71 years, with cysts of the nasopharynx. The outcome variables of complications and the rate of recurrence were analyzed, respectively. Results: In 12 cases, retention cysts in 2 cases, branchial cyst in 1 case, adenoid middle fossa cyst infection in 6 cases, Tornwaldt’s cyst in 3 cases. The use of the coblation device was associated with a significant decrease in blood loss. There were no postoperative complications, and the overall follow-up period was 2-7 years and shows no signs of recurrence. Conclusions: We describe transnasal endoscopic procedures to resect cysts of the nasopharynx. We found that radiofrequency coblation is a useful and safe tool associated with minimal blood loss in the resection of these cysts. In our experience, it has been a highly successful, safe, and effective procedure. PMID:26131108
... Sequence, Crouzon Syndrome, and Treacher Collins Syndrome. Cleftline™ Bears Our Cleftline™ bears bring comfort to children with cleft lip and ... anxiety they experience from having facial differences. Each bear is custom-made with stitches across its upper ...
... presentations/100010.htm Cleft lip repair - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...
Dai, Jie-wen; Wang, Xu-dong; Sun, Hao; Jiang, Wen-hui; Lu, Jing-ting; Shen, Guo-fang
The first branchial arch malformation (FBAM) is a rare congenital defect associated with anomalous development of the first and second branchial arches. Cause of FBAM still remains unknown, and is thought in most cases to be multifactorial, involving both genetic and enviromental factors. Dlx2 as a member of the Dlx homeobox gene family, plays a crucial role in the development of the first branchial arch. The tissues regulated mainly by Dlx2 are coincident with the tissues mainly involved in FBAM. Dlx2 over-expression generated by electroporation transfection can disturb the migration and differentiation of cranial neural crest cells (CNCCs), which migrate to the branchial arches and in turn give rise to much of the facial skeleton and connective tissues. Furthermore, Dlx2 over-expression can be found in the first branchial arch spontaneous mutant mice. So we hypothesize that Dlx2 over-expression mutation causes FBAM due to an increase in cell-cell adhesion and inhibiting the migration of CNCC to the first branchial arch in the early stage, or migrating to an incorrect position and can't differentiate into normal tissues. What an exact role of Dlx2 over-expression in FBAM remains to be investigated and Dlx2 over-expression transgenic mouse will be a nice model for further research in FBAM.
Wilson, Jonathan M; Morgan, John D; Vogl, A Wayne; Randall, David J
In marine teleost fishes, the gill mitochondria-rich cells (MRCs) are responsible for NaCl elimination; however, in elasmobranch fishes, the specialized rectal gland is considered to be the most important site for salt secretion. The role of the gills in elasmobranch ion regulation, although clearly shown to be secondary, is not well characterized. In the present study, we investigated some morphological properties of the branchial MRCs and the localization, and activity of the important ionoregulatory enzyme Na(+)/K(+)-ATPase, under control conditions and following rectal gland removal (1 month) in the spiny dogfish, Squalus acanthias. A clear correlation can be made between MRC numbers and the levels of Na(+)/K(+)-ATPase activity in crude gill homogenates (r(2)=-0.69). Strong Na(+)/K(+)-ATPase immunoreactivity is also clearly associated with the basolateral membrane of these MRCs. In addition, the dogfish were able to maintain ionic balance after rectal gland removal. These results all suggest a possible role of the dogfish gill in salt secretion. MRCs were, however, unresponsive to rectal gland removal in terms of changes in number, fine structure and Na(+)/K(+)-ATPase activity, as might be expected if they were compensating for the loss of salt secretion by the rectal gland. Thus, the specific role that these MRCs play in ion regulation in the dogfish remains to be determined
Pradel, Alan; Maisey, John G; Tafforeau, Paul; Mapes, Royal H; Mallatt, Jon
The evolution of serially arranged, jointed endoskeletal supports internal to the gills--the visceral branchial arches--represents one of the key events in early jawed vertebrate (gnathostome) history, because it provided the morphological basis for the subsequent evolution of jaws. However, until now little was known about visceral arches in early gnathostomes, and theories about gill arch evolution were driven by information gleaned mostly from both modern cartilaginous (chondrichthyan) and bony (osteichthyan) fishes. New fossil discoveries can profoundly affect our understanding of evolutionary history, by revealing hitherto unseen combinations of primitive and derived characters. Here we describe a 325 million year (Myr)-old Palaeozoic shark-like fossil that represents, to our knowledge, the earliest identified chondrichthyan in which the complete gill skeleton is three-dimensionally preserved in its natural position. Its visceral arch arrangement is remarkably osteichthyan-like, suggesting that this may represent the common ancestral condition for crown gnathostomes. Our findings thus reinterpret the polarity of some arch features of the crown jawed vertebrates and invert the classic hypothesis, in which modern sharks retain the ancestral condition. This study underscores the importance of early chondrichthyans in resolving the evolutionary history of jawed vertebrates.
... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...
Mishra, Sobhan; Sabhlok, Samrat; Panda, Pankaj Kumar; Khatri, Isha
Median or midline facial clefts are rare anomalies of developmental origin, etiology of whose occurrence is still unknown precisely. The most basic presentation of midline facial clefts is in the form of a Median cleft lip which is defined as any congenital vertical cleft through the centre of the upper lip. First described by Bechard in 1823, it is the most common amongst all atypical clefts reported. The incidence is about 1:10,00,000 births. This may occur as a sporadic event or as a part of an inherited sequence of anomalies. It arises embryologically from incomplete fusion of the medial nasal prominences. The authors present a series of eight cases with varying degrees of midline facial clefts. This review article aims to give a broad idea on the various classifications used for further understanding of midline facial clefts and a brief idea about the various surgical management techniques used in the repair of these facial clefts.
... Ideas Vehicle Donation Volunteer Efforts Bonegrafting the Cleft Maxilla skip to submenu Parents & Individuals Information for Parents & Individuals Bonegrafting the Cleft Maxilla To download the PDF version of this factsheet, ...
Martinucci, G B; Dallai, R; Burighel, P; Casagrande, L
Tissues from the pharynx of five representative species of the protochordates (subphylum Tunicata, the three classes Ascidiacea, Thaliacea and Appendicularia, and subphylum Cephalochordata) were examined in both thin sections and freeze-fracture replicas. In all species, the stigmatal cilia of the branchial chamber are neatly arranged and move continuously to propel sea-water in a fixed direction for respiration and feeding of the organism. A number of specializations are found in the basal region of these cilia and are represented by: a) bridges connecting axonemal doublets numbers 5 and 6; b) dense fibrous material linking the doublet microtubules of the axoneme to the ciliary membrane, sometimes in the shape of longitudinal strands or as clusters of filaments; c) intramembrane particles (IMPs) associated with the P-face of the membrane, often arranged in clusters evenly aligned along the ciliary shaft in relation to the underlying axonemal doublets. Ciliary specializations are distributed along the plane of the effective stroke of the beat in both the ascidian Botryllus schlosseri and in the thaliacean Pyrosoma atlanticum and the amphioxus Branchiostoma lanceolatum, whereas in the thaliacean Doliolum nationalis and the appendicularian Oikopleura dioica a more uniform distribution of these specializations all around the basal portion of the cilia is observed. Whatever the disposition of the ciliary specializations in all the examined species, they are always present at the base of the water-propelling cilia. Some morphological evidence suggests that these specializations play a mechanical function in tethering the ciliary membrane to the axoneme. We propose that they help maintain the orientation of the cilia during beating, enhance their stiffness and improve their efficiency.
Gary, Celeste; Sykes, Jonathan M
Intermediate and definitive cleft rhinoplasties are a challenging part of definitive cleft care. The anatomy of the cleft nose is severely affected by the structural deficits associated with congenital orofacial clefting. A comprehensive understanding of the related anatomy is crucial for understanding how to improve the appearance and function in patients with secondary cleft nasal deformities. Timing of intermediate and definitive rhinoplasty should be carefully considered. A thorough understanding of advanced rhinoplasty techniques is an important part of providing adequate care for patients with these deformities.
Skach, J; Gawlik, V
The authors present a case report of a female patient with a recurrent mesenteric cyst. Chylous cyst is one of rare diagnoses of a cyst close to the pancreas in patients with no history of acute pancreatitis. Chylous cysts need to be managed radically; otherwise, given their nature, they are likely to recur.
Bilodeau, Elizabeth Ann; Collins, Bobby M
This article reviews a myriad of common and uncommon odontogenic cysts and tumors. The clinical presentation, gross and microscopic features, differential diagnosis, prognosis, and diagnostic pitfalls are addressed for inflammatory cysts (periapical cyst, mandibular infected buccal cyst/paradental cyst), developmental cysts (dentigerous, lateral periodontal, glandular odontogenic, orthokeratinized odontogenic cyst), benign tumors (keratocystic odontogenic tumor, ameloblastoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibroma and fibroodontoma, odontoma, squamous odontogenic tumor, calcifying cystic odontogenic tumor, primordial odontogenic tumor, central odontogenic fibroma, and odontogenic myxomas), and malignant tumors (clear cell odontogenic carcinoma, ameloblastic carcinoma, ameloblastic fibrosarcoma). Copyright © 2016 Elsevier Inc. All rights reserved.
Kushwaha, Jitendra Kumar; Gupta, Rajni; Mohanti, Satyabrot; Kumar, Surender
Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in 13% and it is usually secondary to rupture of primary hepatic cyst. Primary intraperitoeal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. In this article, the author presents a case of primary mesenteric hydatid cyst with chronic pain in lower abdomen.
Kushwaha, Jitendra Kumar; Gupta, Rajni; Mohanti, Satyabrot; Kumar, Surender
Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in 13% and it is usually secondary to rupture of primary hepatic cyst. Primary intraperitoeal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. In this article, the author presents a case of primary mesenteric hydatid cyst with chronic pain in lower abdomen. PMID:22778458
... and Palate? What Do Doctors Do? en español Labio leporino y paladar hendido When Karly talks to her friends, most of them don't know it took years of hard work for her to develop her speech skills. Karly was born with a condition called cleft lip and palate. As a child, she had several ...
Velazquez, Danitza; Pereira, Elaine; Havranek, Thomas
VACTERL (vertebral anomalies, anal atresia, cardiac defect, tracheoesophageal fistula, renal anomaly, limb anomalies) is an association of anomalies with a wide spectrum of phenotypic expression. While the majority of cases are sporadic, there is evidence of an inherited component in a small number of patients as well as the potential influence of nongenetic risk factors (maternal diabetes mellitus). Presence of hydrocephalus has been reported in VACTERL patients (VACTERL-H) in the past, with some displaying branchial arch anomalies. We report the unique case of an infant of diabetic mother with VACTERL association and a branchial arch anomaly-in the absence of hydrocephalus.
Depew, Michael J; Simpson, Carol A; Morasso, Maria; Rubenstein, John LR
The branchial arches are meristic vertebrate structures, being metameric both between each other within the rostrocaudal series along the ventrocephalic surface of the embryonic head and within each individual arch: thus, just as each branchial arch must acquire a unique identity along the rostrocaudal axis, each structure within the proximodistal axis of an arch must also acquire a unique identity. It is believed that regional specification of metameric structures is controlled by the nested expression of related genes resulting in a regional code, a principal that is though to be demonstrated by the regulation of rostrocaudal axis development in animals exerted by the nested HOM-C/Hox homeobox genes. The nested expression pattern of the Dlx genes within the murine branchial arch ectomesenchyme has more recently led to the proposal of a Dlx code for the regional specification along the proximodistal axis of the branchial arches (i.e. it establishes intra-arch identity). This review re-examines this hypothesis, and presents new work on an allelic series of Dlx loss-of-function mouse mutants that includes various combinations of Dlx1, Dlx2, Dlx3, Dlx5 and Dlx6. Although we confirm fundamental aspects of the hypothesis, we further report a number of novel findings. First, contrary to initial reports, Dlx1, Dlx2 and Dlx1/2 heterozygotes exhibit alterations of branchial arch structures and Dlx2−/− and Dlx1/2−/− mutants have slight alterations of structures derived from the distal portions of their branchial arches. Second, we present evidence for a role for murine Dlx3 in the development of the branchial arches. Third, analysis of compound Dlx mutants reveals four grades of mandibular arch transformations and that the genetic interactions of cis first-order (e.g. Dlx5 and Dlx6), trans second-order (e.g. Dlx5 and Dlx2) and trans third-order paralogues (e.g. Dlx5 and Dlx1) result in significant and distinct morphological differences in mandibular arch development
Pérez-Guisado, Joaquín; Scilletta, Alessandra; Cabrera-Sánchez, Emilio; Rioja, Luis F; Perrotta, Rosario
Epidermoid cysts represent the most common cutaneous cysts. They are usually small and benign; however, sometimes they can grow to giant epidermoid cists, and occasionally malignancies develop. Giant epidermoid cysts at the earlobe have never been described but in other locations. We describe a case of a giant epidermoid cyst at the earlobe, a location where such a large cyst has never been reported before. The mass was completely resected and the wound of the pedunculated base was sutured with four stitches of nylon 5/0. Histopathology confirmed the presumptive diagnosis of an epidermoid cyst. Six months after the resection, the patient did not have any relapse of the epidermoid cyst. The earlobe is a potential location for giant epidermoid cysts. Although the clinical diagnosis could be enough, due to the possibility of malignancy and to ensure appropriate diagnosis, we consider that all cysts should be sent to the anatomic pathology laboratory for histological evaluation. PMID:22557855
J, Ashok Raja; G, Mathevan; K, Mathiarasan; P, Ramasubramaniam
Sternal cleft is a rare anomaly comprising 0.5% of chest wall malformations. We present a case of a neonate with a ‘V’-shaped upper partial sternal cleft at birth. A hyperpigmented cutaneous nevi was present over the cleft. Primary approximation and closure of the defect was performed at 1 week of life. We discuss the presentation and management, and review the literature. PMID:25100810
Leslie, Elizabeth J.; Marazita, Mary L.
Orofacial clefts are common birth defects and can occur as isolated, nonsyndromic events or as part of Mendelian syndromes. There is substantial phenotypic diversity in individuals with these birth defects and their family members: from subclinical phenotypes to associated syndromic features that is mirrored by the many genes that contribute to the etiology of these disorders. Identification of these genes and loci has been the result of decades of research using multiple genetic approaches. Significant progress has been made recently due to advances in sequencing and genotyping technologies, primarily through the use of whole exome sequencing and genome-wide association studies. Future progress will hinge on identifying functional variants, investigation of pathway and other interactions, and inclusion of phenotypic and ethnic diversity in studies. PMID:24124047
Leslie, Elizabeth J; Marazita, Mary L
Orofacial clefts are common birth defects and can occur as isolated, nonsyndromic events or as part of Mendelian syndromes. There is substantial phenotypic diversity in individuals with these birth defects and their family members: from subclinical phenotypes to associated syndromic features that is mirrored by the many genes that contribute to the etiology of these disorders. Identification of these genes and loci has been the result of decades of research using multiple genetic approaches. Significant progress has been made recently due to advances in sequencing and genotyping technologies, primarily through the use of whole exome sequencing and genome-wide association studies. Future progress will hinge on identifying functional variants, investigation of pathway and other interactions, and inclusion of phenotypic and ethnic diversity in studies. © 2013 Wiley Periodicals, Inc.
Kaufman, Yoav; Buchanan, Edward P.; Wolfswinkel, Erik M.; Weathers, William M.; Stal, Samuel
The cleft nasal deformity is a complex challenge in plastic surgery involving the skin, cartilage, mucosa, and skeletal platform. Ever since Blair and Brown first described the intricacies of the cleft pathology in 1931, the appropriate approach has been extensively debated in the literature with respect to timing, technique, and extent of surgical intervention. In this article, the authors review the literature and summarize the various modalities for achieving a successful rhinoplasty in the patient with a cleft nasal deformity. PMID:24179452
Mulliken, John B
The surgeon's objectives are normal nasolabial appearance and normal speech. The principles for synchronous repair of bilateral cleft lip have been established, and the techniques continue to evolve. Primary repair impairs maxillary growth, but little can be done at this time except to practice gentle craftsmanship and to minimize tension on the lower labial closure. The cutaneous lip should never be reopened for revision, and the number of secondary procedures involving the nasal cartilages should be kept to a minimum. Many adolescents with repaired bilateral cleft lip need maxillary advancement to improve projection of the nasal tip, to protrude the upper lip, and to attain normal sagittal skeletal harmony. With expected improvements in the technology of distraction osteogenesis, maxillary advancement may someday become as acceptable as orthodontic treatment.
Baginski, F.; Schur, W.
NASA's effort to develop a large payload, high altitude, long duration balloon, the Ultra Long Duration Balloon, focuses on a pumpkin shape super-pressure design. It has been observed that a pumpkin balloon may be unable to pressurize into the desired cyclically symmetric equilibrium configuration, settling into a distorted, undesired stable state instead. Hoop stress considerations in the pumpkin design leads to choosing the lowest possible bulge radius, while robust deployment is favored by a large bulge radius. Some qualitative understanding of design aspects on undesired equilibria in pumpkin balloons has been obtained via small-scale balloon testing. Poorly deploying balloons have clefts, but most gores away from the cleft deploy uniformly. In this paper, we present models for pumpkin balloons with clefts. Long term success of the pumpkin balloon for NASA requires a thorough understanding of the phenomenon of multiple stable equilibria and means for quantitative assessment of measures that prevent their occurrence. This paper attempts to determine numerical thresholds of design parameters that distinguish between properly deploying designs and improperly deploying designs by analytically investigating designs in the vicinity of criticality. Design elements which may trigger the onset undesired equilibria and remedial measures that ensure deployment are discussed.
... shape, size, location, and makeup of the cyst. • Laparoscopy —In this type of surgery, a laparoscope—a ... into the abdomen to view the pelvic organs. Laparoscopy also can be used to treat cysts. • Blood ...
Kleinteich, Thomas; Haas, Alexander
Amphibians (Lissamphibia) are characterized by a bi-phasic life-cycle that comprises an aquatic larval stage and metamorphosis to the adult. The ancestral aquatic feeding behavior of amphibian larvae is suction feeding. The negative pressure that is needed for ingestion of prey is created by depression of the hyobranchial apparatus as a result of hyobranchial muscle action. Understanding the homologies of hyobranchial muscles in amphibian larvae is a crucial step in understanding the evolution of this important character complex. However, the literature mostly focuses on the adult musculature and terms used for hyal and ventral branchial muscles in different amphibians often do not reflect homologies across lissamphibian orders. Here we describe the hyal and ventral branchial musculature in larvae of caecilians (Gymnophiona) and salamanders (Caudata), including juveniles of two permanently aquatic salamander species. Based on previous alternative terminology schemes, we propose a terminology for the hyal and ventral branchial muscles that reflects the homologies of muscles and that is suited for studies on hyobranchial muscle evolution in amphibians. We present a discussion of the hyal and ventral branchial muscles in larvae of the most recent common ancestor of amphibians (i.e. the ground plan of Lissamphibia). Based on our terminology, the hyal and ventral branchial musculature of caecilians and salamanders comprises the following muscles: m. depressor mandibulae, m. depressor mandibulae posterior, m. hyomandibularis, m. branchiohyoideus externus, m. interhyoideus, m. interhyoideus posterior, m. subarcualis rectus I, m. subarcualis obliquus II, m. subarcualis obliquus III, m. subarcualis rectus II-IV, and m. transversus ventralis IV. Except for the m. branchiohyoideus externus, all muscles considered herein can be assigned to the ground plan of the Lissamphibia with certainty. The m. branchiohyoideus externus is either apomorphic for the Batrachia (frogs
Hirst, Jane E; Torode, Hugh; Sears, William; Cousins, Michael J
Tarlov cysts are sacral perineural cysts. This case report describes the clinical course after biopsy of a very large Tarlov cyst via laparoscopy, which was thought preoperatively to be an adnexal mass. It serves as a warning against attempting biopsy or resection of these lesions.
Sivasankar, Vaishnavi; Ranganathan, Kannan; Praveen, B
Keratinizing dentigerous cyst is a rare entity. This article reports a case of keratinizing dentigerous cyst associated with an impacted mandibular canine. Clinical and radiological features, cone-beam computed tomography findings and histological features of the case are reported along with a discussion on keratinizing odontogenic cysts and the need for follow-up. PMID:24808713
Rajalakshmi, R; Sreeja, C; Vijayalakshmi, D; Leelarani, V
Orthokeratinised odontogenic cyst (OOC) denotes the odontogenic cyst that microscopically has an orthokeratinised epithelial lining. OOC is characterised by a less-aggressive behaviour and a low rate of recurrence. This report describes a case of OOC involving posterior part of the mandible that mimicked periapical cyst in a 14-year-old boy. The initial clinical diagnosis was given as periapical cyst based on the clinical and radiographical features. Enucleation of the cyst was performed and the specimen was sent for histopathological examination. A definite diagnosis of OOC was made by histopathological examination of the biopsy specimen. This case emphases on including OOC in the differential diagnosis of radiolucencies occurring in the periapical region of non-vital tooth. PMID:24099763
Rajalakshmi, R; Sreeja, C; Vijayalakshmi, D; Leelarani, V
Orthokeratinised odontogenic cyst (OOC) denotes the odontogenic cyst that microscopically has an orthokeratinised epithelial lining. OOC is characterised by a less-aggressive behaviour and a low rate of recurrence. This report describes a case of OOC involving posterior part of the mandible that mimicked periapical cyst in a 14-year-old boy. The initial clinical diagnosis was given as periapical cyst based on the clinical and radiographical features. Enucleation of the cyst was performed and the specimen was sent for histopathological examination. A definite diagnosis of OOC was made by histopathological examination of the biopsy specimen. This case emphases on including OOC in the differential diagnosis of radiolucencies occurring in the periapical region of non-vital tooth.
Moore, M H; Edwards, T J; David, D J
Sutural anomalies in conjunction with craniofacial clefting are unusual. A case of median frontal clefting is presented in which there was an absence of a normal metopic suture and replacement by paramedian frontal sutures. The association of an underlying brain anomaly, with attendant surgical difficulties, is noted, as are the radiological techniques of preoperative diagnosis.
Sharif, Robin; Moscovici, Samuel; Wygoda, Marc; Eliahou, Ruth; Spektor, Sergey
Cerebellar cyst is a known but uncommon entity. It is congenital in most cases, or may develop after brain parenchyma injuries or interventions. To our knowledge, de novo cerebellar cyst after extra-axial tumor excision, has not been described in the literature. We present the first reported case of a de novo cerebellar cyst developing in a 70-year-old woman following retrosigmoid craniotomy for vestibular schwannoma excision, and discuss the possible causes. Following cyst fenestration, there was no clinical or radiological evidence of a residual cyst. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kahraman, Serdar; Anik, Ihsan; Gocmen, Selcuk; Sirin, Sait
Background: Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Enlargement may cause progressive signs and symptoms caused by spinal cord compression. They are associated with trauma, surgery, arachnoiditis, and neural tube defects. Most nontraumatic spinal extradural arachnoid cysts are thought to be congenital. Design: Case report and literature review. Findings: A 9-year-old boy with mild paraparesis was found to have an extradural multiloculated arachnoid cyst with fibrous septa at T4-L3 levels and anterior compression and displacement of the spinal cord. Conclusions: Definitive treatment of arachnoid cyst entails radical cyst removal and dura cleft repair. Formation of a postoperative cerebrospinal fluid fistula may require external lumbar drainage. PMID:18795482
Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst. The video can be found here: http://youtu.be/pgUrl9xvsD0.
RUTHERFORD, DAVID; WESTLAKE, HAROLD
DESIGNED TO PROVIDE AN ESSENTIAL CORE OF INFORMATION, THIS BOOK TREATS NORMAL AND ABNORMAL DEVELOPMENT, STRUCTURE, AND FUNCTION OF THE LIPS AND PALATE AND THEIR RELATIONSHIPS TO CLEFT LIP AND CLEFT PALATE SPEECH. PROBLEMS OF PERSONAL AND SOCIAL ADJUSTMENT, HEARING, AND SPEECH IN CLEFT LIP OR CLEFT PALATE INDIVIDUALS ARE DISCUSSED. NASAL RESONANCE…
Orofacial clefts are one of the commonest birth defects, and may be associated with other congenital anomalies. The majority of these orofacial clefts are nonsyndromic. A significant percentage of these clefts both syndromic and non-syndromic may have associated anomalies. Apart from reviewing other studies, this article also analyses a study of associated anomalies from a tertiary cleft centre in India. PMID:19884681
RUTHERFORD, DAVID; WESTLAKE, HAROLD
DESIGNED TO PROVIDE AN ESSENTIAL CORE OF INFORMATION, THIS BOOK TREATS NORMAL AND ABNORMAL DEVELOPMENT, STRUCTURE, AND FUNCTION OF THE LIPS AND PALATE AND THEIR RELATIONSHIPS TO CLEFT LIP AND CLEFT PALATE SPEECH. PROBLEMS OF PERSONAL AND SOCIAL ADJUSTMENT, HEARING, AND SPEECH IN CLEFT LIP OR CLEFT PALATE INDIVIDUALS ARE DISCUSSED. NASAL RESONANCE…
Funato, Noriko; Nakamura, Masataka; Yanagisawa, Hiromi
Cleft palate, including complete or incomplete cleft palates, soft palate clefts, and submucosal cleft palates, is the most frequent congenital craniofacial anomaly in humans. Multifactorial conditions, including genetic and environmental factors, induce the formation of cleft palates. The process of palatogenesis is temporospatially regulated by transcription factors, growth factors, extracellular matrix proteins, and membranous molecules; a single ablation of these molecules can result in a cleft palate in vivo. Studies on knockout mice were reviewed in order to identify genetic errors that lead to cleft palates. In this review, we systematically describe these mutant mice and discuss the molecular mechanisms of palatogenesis. PMID:26322171
Shetty, Devi Charan; Rathore, Ajit Singh; Jain, Anshi; Thokchom, Natasha; Khurana, Neha
The orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst that has been considered as a variant of the keratocystic odontogenic tumor until Wright (1981) defined it as a different entity. Recognition of OOC as a unique entity has long been due, yet its inexplicable clinical, radiographic presentation resembling dentigerous cyst due to its association to an impacted tooth, and its histological features makes it rather perplexing. This is the report of a case of OOC in relation to an impacted maxillary canine and its immunohistochemical analysis with Ki-67. PMID:27857903
Martinez-Perez, Rafael; Hinojosa, José; Pascual, Beatriz; Panaderos, Teresa; Welter, Diego; Muñoz, María J
The therapeutic management of arachnoid cysts depends largely on its location. Almost 50% of arachnoid cysts are located in the temporal fossa-Sylvian fissure, whereas the other half is distributed in different locations, sometimes exceptional. Under the name of infrequent location arachnoid cysts, a description is presented of those composed of 2 sheets of arachnoid membrane, which are not located in the temporal fossa, and are primary or congenital. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.
Cho, Sung Min; Rhee, Woo Tack; Choi, Soo Jung; Eom, Dae Woon
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
Woo, Joon Bum; Kang, Kyung Taek; Lee, Jun Seok; Song, Geun Seong; Sung, Soon Ki; Lee, Sang Weon
A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy. PMID:27857934
Stoler, Joan M; Rosen, Heather; Desai, Urmen; Mulliken, John B; Meara, John G; Rogers, Gary F
The frequency of associated cleft palate is known to be high in some fibroblast growth factor receptor 2 (FGFR2)-mediated craniosynostosis syndromes, such as Apert syndrome. However, there is little information on the frequency of palatal clefts in the FGFR2-mediated disorder, that is, Pfeiffer syndrome. The purpose of this study was to determine the frequency of palatal clefts in patients with Pfeiffer syndrome. The records of patients with Pfeiffer syndrome managed in our craniofacial unit were reviewed. Only patients with a confirmed diagnosis of Pfeiffer syndrome were included. Diagnostic criteria were as follows: characteristic mutations in FGFR1 or FGFR2 or, in the absence of genetic testing, clinical findings consistent with Pfeiffer syndrome as determined by a clinical geneticist or our most experienced surgeon (J.B.M.). Only 2 clefts were noted in 25 patients (8%), including 1 with a submucous cleft and 1 with an overt palatal cleft. Many patients (87%) were described as having a high-arched and narrow palate, and 1 had a low, broad palate. Nine patients were noted to have choanal atresia or stenosis. Clefting of the palate does occur in Pfeiffer syndrome but at a low frequency.
In the maintenance of respiratory activity of the gills in fishes, mucus secretion is known to have an important function. Crude oils and their fractions enter the fish tissue by positive transfer via the gills thus the mucus cells of gill epithelia act as an obvious site of pathogenic interactions between the fish and the environment. Mucous cell hyperplasia is a general phenomenon associated with crude oil toxicity. Even though a large quantity of crude oil pollutes the freshwater environment annually, literatures on the pathogenic effect of oil pollutants on the branchial mucous cells of fishes are limited to the marine and estuarine species. This investigation has been undertaken to provide a better understanding of the pathogenic effects of crude oil on the branchial mucous of a freshwater fish, Colisa fasciatus. The toxicity assessment is based on the histochemical observations of mucous cells present in the epithelia of gill rakers and filaments.
Rodríguez Vázquez, José Francisco
In the human embryo, the second branchial arch has a cartilaginous structure called Reichert's cartilage named alter its discoverer who first classified the visceral arches in 1837. The concept of Reichert's cartilage is still interpreted today as a structure that gives rise to the stapes of the middle ear, to the styloid process, to the styloid ligament, the lesser horns and the superior part of the hyoid body. The normal pattern of the cartilage of the second branchial arch has been studied in human fetuses, giving rise to a new interpretation. It has been classified into two parts, one longer cranial one joined to the otic capsule and another smaller caudal one associated with the hyoid bone. In our opinion, variability in the shape and the arrangement of the cranial portion will condition the formation of a styloid process of different length and morphology. Our studies of this cartilage explain the mechanism by which certain craniofacial variations with clinical implications can arise.
Cooper, Margaret E; Ratay, Jessica S; Marazita, Mary L
To determine the clefting birth prevalence among Asian populations, specifically Chinese and Japanese, using raw counts from nonoverlapping published studies of Asian populations, and to investigate whether Asian clefting rates have been interpreted accurately as being up to twice the Caucasian rate. A literature review of articles giving raw counts of clefting in Asian populations, primarily Japanese and Chinese. Where possible, clefts were identified by the patients' ethnicity, country of origin, cleft type, syndromic status, and birth status. Prevalence rates of cleft lip with or without cleft palate per 1000 live births are reported. Syndromic plus nonsyndromic cleft lip with or without cleft palate: Chinese, 1.30; Japanese, 1.34; Other Asian, 1.47; and total, 1.33. Nonsyndromic cleft lip with or without cleft palate: Chinese, 1.20; Japanese, 1.18; Other Asian, 1.22; and total, 1.19. Overall, Chinese and Japanese live birth prevalence rates for nonsyndromic cleft lip with or without cleft palate, based on the published reports of birth prevalence, are significantly lower than the oft-quoted rate of 2 per 1000 for Asians. The apparent reason for the discrepancy is that many published prevalence rates included all pregnancies (live births plus pregnancy losses) and do not distinguish between syndromic and nonsyndromic clefts or between cleft palate alone and cleft lip with or without cleft palate. These results demonstrate that it is extremely important for current population-based studies of clefts to include careful delineation of population groups, syndromes, cleft type, and birth status.
Joice, P; Sudarshan, T; Hussain, S S M
To report a case of first branchial arch abnormality and the problems associated with misdiagnosis. A succinct literature review is included. Teaching hospital in Scotland. A 10-year-old girl presented with localised erythema and swelling in the left parotid region. This was treated with antibiotics and incision and drainage. She re-presented four years later with a history of recurrent discharge. A first branchial arch abnormality was suspected and a magnetic resonance imaging scan arranged. Imaging showed a fluid-filled sinus tract originating adjacent to the anterior wall of the cartilaginous left external auditory canal. The sinus tract was seen to extend anteriorly and inferiorly through the superficial lobe of the left parotid, and to open onto the left cheek lateral to the left masseter. The tract was explored and excised under general anaesthesia, via two separate incisions, with preservation of the facial nerve. The diagnosis of a first branchial arch abnormality is generally based on a high index of clinical suspicion, when a neck swelling is noted in a child. Magnetic resonance imaging is a useful modality for investigation, and helps to delineate the position of the tract and its relationship to the facial nerve.
Erickson, Priscilla A; Glazer, Andrew M; Cleves, Phillip A; Smith, Alyson S; Miller, Craig T
In convergent evolution, similar phenotypes evolve repeatedly in independent populations, often reflecting adaptation to similar environments. Understanding whether convergent evolution proceeds via similar or different genetic and developmental mechanisms offers insight towards the repeatability and predictability of evolution. Oceanic populations of threespine stickleback fish, Gasterosteus aculeatus, have repeatedly colonized countless freshwater lakes and streams, where new diets lead to morphological adaptations related to feeding. Here, we show that heritable increases in branchial bone length have convergently evolved in two independently derived freshwater stickleback populations. In both populations, an increased bone growth rate in juveniles underlies the convergent adult phenotype, and one population also has a longer cartilage template. Using F2 crosses from these two freshwater populations, we show that two quantitative trait loci (QTL) control branchial bone length at distinct points in development. In both populations, a QTL on chromosome 21 controls bone length throughout juvenile development, and a QTL on chromosome 4 controls bone length only in adults. In addition to these similar developmental profiles, these QTL show similar chromosomal locations in both populations. Our results suggest that sticklebacks have convergently evolved longer branchial bones using similar genetic and developmental programmes in two independently derived populations. © 2014 The Author(s) Published by the Royal Society. All rights reserved.
Arunachalam, Pavai; Vaidyanathan, Venkatraman; Sengottan, Palaninathan
Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out.
Yasui, Kinya; Kaji, Takao; Morov, Arseniy R; Yonemura, Shigenobu
The perforated pharynx has generally been regarded as a shared characteristic of chordates. However, there still remains phylogenetic ambiguity between the cilia-driven system in invertebrate chordates and the muscle-driven system in vertebrates. Giant larvae of the genus Asymmetron were reported to develop an orobranchial musculature similar to that of vertebrates more than 100 years ago. This discovery might represent an evolutionary link for the chordate branchial system, but few investigations of the lancelet orobranchial musculature have been completed since. We studied staged larvae of a Japanese population of Branchiostoma japonicum to characterize the developmental property of the orobranchial musculature. The larval mouth and the unpaired primary gills develop well-organized muscles. These muscles function only as obturators of the openings without antagonistic system. As the larval mouth enlarged posteriorly to the level of the ninth myomere, the oral musculature was fortified accordingly without segmental patterning. In contrast, the iterated branchial muscles coincided with the dorsal myomeric pattern before metamorphosis, but the pharynx was remodeled dynamically irrespective of the myomeric pattern during metamorphosis. The orobranchial musculature disappeared completely during metamorphosis, and adult muscles in the oral hood and velum, as well as on the pterygial coeloms developed independently. The lancelet orobranchial musculature is apparently a larval adaptation to prevent harmful intake. However, vestigial muscles appeared transiently with the secondary gill formation suggest a bilateral ancestral state of muscular gills, and a segmental pattern of developing branchial muscles without neural crest and placodal contributions is suggestive of a precursor of vertebrate branchiomeric pattern.
Fox, G Q; Richardson, G P; Kirk, C
The fourth branchial arch of Torpedo marmorata has been examined at the light and electron microscopic level during development. Of interest was the determination of the extent of electric organ tissue reported to be present in this arch and its possible relationship to electromotoneuron cell death in the electric lobes. The main electric organ of the torpedo is derived from the hyoid and first three branchial arches and is innervated by four major electromotor nerves. Extensive electromotoneuron cell death occurs in the electric lobes and most notably in the posterior poles. This feature could be due to a tendency for these neurons to innervate the fourth branchial arch where little or no electric tissue is formed. Our findings support this conclusion but are not entirely consistent with the idea that a population mismatch has occurred. This is because cell death precedes the genesis of the target cells. The presence of innervated differentiated electric tissue in this arch is also reported, leading to the conclusion that Torpedo marmorata possesses an accessory electric organ.
Ciment, G; Weston, J A
We have previously described a monoclonal antibody (E/C8) that recognizes an avian-specific epitope present in a variety of embryonic cells, including some cultured neural crest cells, both central and peripheral neurones in vivo, and apparently non-neuronal neural crest-derived mesenchymal cells of the posterior (third and fourth) branchial arches. The branchial arches are transient embryonic structures that serve as the lateral and ventral walls of the primitive pharynx of vertebrates and are contiguous with the developing gut. We report here that E/C8-positive mesenchymal cells of the arches can develop into neurones spontaneously in culture, or can migrate into aneural guts with which they are co-cultured and form enteric ganglia. In contrast, these cells do not develop into melanocytes--another derivative of the neural crest--in various permissive conditions. These results demonstrate that the mesenchymal cells of the posterior branchial arches are a developmentally restricted population of neural crest-derived cells, and some may serve as precursors for neurones of the enteric nervous system.
Hortis-Dzierzbicka, M A
The early restoration of facial and palatal morphology in patients with cleft of lip and/or palate provides the anatomical base for good speech outcome. The author gives the up todate overview of the main problems concerning cleft speech, such as velopalatal insufficiency and typical articulation errors. The article describes the modern methods for the evaluation of VPI and current trends in treatment modalities for VPI.
Reddy, G Ramesh; Gunadal, Shankar; Banda, Vanaja Reddy; Banda, Naveen Reddy
Mesenteric cyst is a rare condition. Presentation with non-typhoid spontaneous infection in an unusual area makes it even more a rare situation with mesenteric cyst. Its diagnosis is mainly based on the imaging modalities. However, there are difficulties in diagnosis when it is present in an uncommon area and rare known complications. Mesenteric cyst can present with few uncommon emergency conditions which pose difficulties in diagnosis as well as treatment options as mentioned in this case.
Reddy, G Ramesh; Gunadal, Shankar; Banda, Vanaja Reddy; Banda, Naveen Reddy
Mesenteric cyst is a rare condition. Presentation with non-typhoid spontaneous infection in an unusual area makes it even more a rare situation with mesenteric cyst. Its diagnosis is mainly based on the imaging modalities. However, there are difficulties in diagnosis when it is present in an uncommon area and rare known complications. Mesenteric cyst can present with few uncommon emergency conditions which pose difficulties in diagnosis as well as treatment options as mentioned in this case. PMID:23605820
Choi, Seung Won; Seong, Han Yu
Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463
Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H.
Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy. PMID:24765349
Guduk, Mustafa; Sun, Halil Ibrahim; Sav, Murat Aydin; Berkman, Zafer
Abstract Colloid cysts appear most commonly in the third ventricle, their occurrence in the sellar region is uncommon. The authors report a female patient with a pituitary colloid cyst. She was diagnosed incidentally with a sellar lesion by a routine paranasal computed tomography examination performed for planning of a dental implant surgery. Radiologic examinations revealed a pituitary lesion that was removed by transnasal transsphenoidal route. Her pathologic examination revealed that the lesion was a colloid cyst. Although rare, colloid cysts should be considered in the differential diagnosis of pituitary lesions PMID:27792102
Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H
Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy.
... graft; 2) prosthetic replacement (dental bridge); or 3) dental metallic bone implants. The best option for an individual patient is best decided by the dental specialists on the cleft palate team. (See Replacing ...
Goldstein, Jesse A; Brown, Benjamin J; Mason, Patrick; Basci, Deniz; Hindenburg, Lora; Dufresne, Craig R; Baker, Stephen B
Standards of cleft care abroad differ from those in the United States, particularly in less developed countries, where international adoption rates are high. Children adopted from these countries present to plastic surgeons in the United States at various ages and states of repair. The operative and perioperative needs of these children are poorly understood. This study attempts to characterize the preadoption history, the postadoption course, and surgical outcomes of children adopted with cleft deformities. The authors performed a retrospective review of all adopted cleft lip-cleft palate patients presenting to an academic craniofacial referral center and compared outcomes among adopted children who were repaired abroad, adopted children who underwent repair performed by the two senior authors (C.R.D. and S.B.B.), and children born in the United States who underwent repair performed by one of the senior authors (S.B.B.) : Between May of 1993 and August of 2010, 83 adopted children with cleft deformities were evaluated in the authors' craniofacial center. Average age at adoption was 30.5 months (range, 5.0 to 95.0 months). Comparing outcomes among adopted children repaired abroad, adopted children repaired by the senior authors, and children born in the United States who underwent repair in the United States, the authors found no statistically significant differences in lip revision rates, fistula rates, or velopharyngeal insufficiency. Adopted cleft patients constitute a complex and variable population with high rates of revision and delayed presentation. Internationally adopted children with orofacial clefts fared no better or worse after undergoing primary cleft repair abroad or in the United States.
Wei, Xiang; Omo, Alfred; Pan, Tiecheng; Li, Jun; Liu, Ligang; Hu, Min
Bronchogenic cysts occurring in the left ventricle are a medical rarity. One successfully operated case is reported herein. The location of the cyst was just between the epicardium and myocardium of the inferior left ventricular wall, adjacent to the apex of the heart. Complete excision was achieved through a left anterolateral thoracotomy without extracorporeal circulation.
Marques, Inês Brás; Vieira Barbosa, José
Arachnoid cysts are benign congenital cerebrospinal fluid collections, usually asymptomatic and diagnosed incidentally in children or adolescents. They may become symptomatic after enlargement or complications, frequently presenting with symptoms of intracranial hypertension. We report an unusual case of progressive refractory headache in an adult patient due to an arachnoid cyst spontaneous rupture. Although clinical improvement occurred with conservative treatment, the subdural hygroma progressively enlarged and surgical treatment was ultimately needed. Spontaneous rupture is a very rare complication of arachnoid cysts. Accumulation of cerebrospinal fluid accumulation in the subdural space causes sustained intracranial hypertension that may be life-threatening and frequently requires surgical treatment. Patients with arachnoid cysts must be informed on their small vulnerability to cyst rupture and be aware that a sudden and severe headache, especially if starting after minor trauma or a Valsalva manoeuvre, always requires medical evaluation.
Joshua, Ben Zion; Raveh, Eyal; Saute, Milton; Schwarz, Michael; Tobar, Ana; Feinmesser, Raphael
Thymic cysts are rare lesions of the anterior mediastinum or neck. The majority are asymptomatic, and the remainder are associated mainly with symptoms of dysphagia or dyspnea. Diagnosis is difficult before surgery. Cervical thymic cysts are relatively rare; age at presentation ranges from the neonatal period to adulthood, and the most frequent presenting sign is a lateral neck mass. Mediastinal thymic cysts are more common and account for 1% of all mediastinal masses. They tend to occur in the older age group and are usually detected incidentally on chest X-ray film or computed tomography scans. Dysphagia and dyspnea are the main symptoms. We describe two brothers, aged 5 and 8 years, with mediastinal thymic cysts that presented as low cervical masses and review the embryology, diagnosis and management of thymic cysts.
Robbins, F G; Yellin, A E; Lingua, R W; Craig, J R; Turrill, F L; Mikkelsen, W P
Four patients with splenic masses were operated upon and found to have epidermoid cysts of the spleen, a rare lesion comprising less than 10% of benign, nonparasitic splenic cysts. The patients were young and had vague, non-specific symptoms which were related to the size of the slowly enlarging splenic mass. Three patients had palpable masses. Contrast gastrointestinal studies and intravenous urography will help exclude mass lesions of the gastrointestinal or genitourinary tract. Sonar scan may confirm the cystic nature of the lesion and localize it to the spleen. A review of 42,327 autopsy records at the Los Angeles County--University of Southern California Medical Center revealed 32 benign splenic cysts found incidentally at autopsy. Hemorrhage, infection, rupture, and rarely, malignant change are complications of splenic cysts. Splenectomy is recommended to eliminate the symptoms produced by the cyst and prevent the potential complications. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:637577
Gupta, Rakesh Kumar; Sah, Suresh; Sah, Panna Lal; Shah, Birendra Prasad
Congenital omental cysts are rare intra-abdominal pathology, which are difficult to diagnose preoperatively; as such a high index of suspicion is required for accurate preoperative diagnosis. We present a case of congenital omental cyst in a 3-year-old girl who presented with huge abdominal distension. We performed diagnostic examinations including ultrasonography and CT of the abdomen. An omental cyst was diagnosed because of its position and connection to the surrounding tissues. She was operated and cyst was excised completely. Histological examination revealed an omental cyst with endothelial lining and haemorrhagic fluid inside. She had an uneventful recovery and doing well, without recurrence at follow-up of 24 months. Clinicians must rigorously pursue a preoperative diagnosis, as it may prevent a surprise upon laparotomy and result in proper management. PMID:22865812
Suen, Matthew; Fung, B; Lung, C P
Ganglion cysts are soft tissue swellings occurring most commonly in the hand or wrist. Apart from swelling, most cysts are asymptomatic. Other symptoms include pain, weakness, or paraesthesia. The two main concerns patients have are the cosmetic appearance of the cysts and the fear of future malignant growth. It has been shown that 58% of cysts will resolve spontaneously over time. Treatment can be either conservative or through surgical excision. This review concluded that nonsurgical treatment is largely ineffective in treating ganglion cysts. However, it advised to patients who do not surgical treatment but would like symptomatic relief. Compared to surgery, which has a lower recurrence rate but have a higher complication rate with longer recovery period. It has been shown that surgical interventions do not provide better symptomatic relief compared to conservative treatment. If symptomatic relief is the patient's primary concern, a conservative approach is preferred, whilst surgical intervention will decrease the likelihood of recurrence.
McDonald, Eugene T.; Berlin, Asa J.
Intended for parents of children with cleft lip and cleft palate, the booklet provides an overview of the condition. Addressed are the following topics (sample subtopics in parentheses): prenatal development and birth defects (facial development); possible causes of cleft lip/cleft palate (common misconceptions, genetic factors, environmental…
McDonald, Eugene T.; Berlin, Asa J.
Intended for parents of children with cleft lip and cleft palate, the booklet provides an overview of the condition. Addressed are the following topics (sample subtopics in parentheses): prenatal development and birth defects (facial development); possible causes of cleft lip/cleft palate (common misconceptions, genetic factors, environmental…
Lie, Rolv T.; Wilcox, Allen J; Taylor, Jack; Gjessing, Håkon K.; Saugstad, Ola Didrik; Aabyholm, Frank; Vindenes, Halvard
Background There is evidence for an effect of cigarette smoking on risk of oral clefts. There are also hypothetical pathways for a biological effect involving toxic chemicals in cigarette smoke. Methods We performed a combined case-control and family-triad study of babies born in Norway with oral clefts in the period 1996 to 2001, with 88% participation among cases (n=573) and 76% participation among controls (n=763). Mothers completed a questionnaire three months after birth of the baby. DNA was collected from parents and children, and assayed for genes related to detoxification of compounds of cigarette smoke (NAT1, NAT2, CYP1A1, GSTP1, GSTT1 and GSTM1). Results For isolated cleft lip (with or without cleft palate) there was a dose-response effect of smoking in the first trimester. The odds ratio rose from 1.6 (95% CI: 1.0 - 2.5) for passive smoking to 1.9 (95% CI: 0.9 - 4.0) for mothers who smoked more than 10 cigarettes per day. There was little evidence of an association with cleft palate. Genetic analyses used both case-control and family-triad data. In case-triads we found an association between a NAT2 haplotype and isolated cleft lip (RR of 1.6 in single dose and 2.5 in double dose), but with little evidence of interaction with smoking. Other genes did not show associations, and previously described interactions with smoking were not confirmed. Conclusion First-trimester smoking was clearly associated with risk of cleft lip. This effect was not modified by variants of genes related to detoxification of compounds of cigarette smoke. PMID:18449058
Sathananthan, N; Moseley, I F; Rose, G E; Wright, J E
Periorbital dermoid cysts should be removed because they commonly leak their irritant contents into the surrounding tissues. The underlying bone may, however, be involved in patients with dermoid cysts at the outer canthus. Computed tomography studies of 70 patients (43 men and 27 women, aged 30 months to 63 years, mean 29 years) with proved dermoid cysts of this type were reviewed. The lesion was always unilateral; 34 were on the left. The bone of the lateral wall and superotemporal angle of the orbit showed the following abnormalities, often in combination: pressure erosion in 61 cases and an otherwise abnormal shape, probably developmental, in 55; the dermoid cyst entered a tunnel or canal through the lateral wall in 24; a blind pit or crater in 15; and a cleft in 20; many patients also showed abnormal bone texture. These findings are extremely important for planning adequate surgery, and indicate that bony involvement is much more frequent than previously appreciated. Images PMID:8110674
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Powell, C S; Sawyers, J L; Reynolds, V H
A review of the English literature reveals a total of 1,337 patients with choledochal cysts. Improved diagnostic techniques to visualize the biliary system are demonstrating an increasing number of unsuspected choledochal cysts in adult patients. Either choledochal cysts remain clinically silent until adulthood or may develop in later life. Experience is reported with adult patients having type I, II, III, and IV choledochal cysts. Type I cysts are preferably managed by excision but cyst anatomy may necessitate choledochoenteric drainage. Type II cysts are treated by excision except for those located within the pancreatic portion of the common bile duct. These are best managed by transduodenal cystoduodenostomy. The type III cyst (choledochocele) should be excised carefully, identifying and preserving the common bile and pancreatic ducts. Type IV cysts include a combination of any one of the first three types of cyst plus the presence of intrahepatic cyst or cysts. Treatment of these cysts is dictated by the type and location of the extrahepatic cyst. Since choledochal cysts are being recognized with increased frequency in adults, surgeons need to be aware of the diagnostic and treatment modalities available for each type of biliary cyst. Images Fig. 3. Fig. 4. Fig. 6. Fig. 7. Fig. 9. Fig. 10. PMID:7235770
Justin, Grant A; Brietzke, Scott E
This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes. The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate. Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean = $2,470,552, range = $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P = .0101). Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.
Singh, Pankaj Kumar; Singh, Vinay Kumar; Azam, Amir; Gupta, Sanjeev
Background/Objective: Tarlov cysts or spinal perineurial cysts are uncommon lesions. These are mostly incidental findings on magnetic resonance imaging or myelograms. The objectives of this study were to describe Tarlov cysts of the sacral region as a potential cause for retrograde ejaculations and review available management options. Methods: Case report and literature review. Results: A 28-year-old man presented with back pain and retrograde ejaculations resulting in infertility. After microsurgical excision of large perineurial cysts, back pain resolved, but semen quality showed only marginal improvement. Later, the couple successfully conceived by intrauterine insemination. To the best of our knowledge, this is the first reported case of Tarlov cyst associated with retrograde ejaculation and infertility. Conclusions: Despite being mostly asymptomatic and an incidental finding, Tarlov cyst is an important clinical entity because of its tendency to increase in size with time. Tarlov cysts of the sacral and cauda equina region may be a rare underlying cause in otherwise unexplained retrograde ejaculations and infertility. Microsurgical excision may be a good option in a select group of patients. PMID:19569467
Rico-Cotelo, María; Diaz-Cabanas, Lucía; Allut, Alfredo G; Gelabert-Gonzalez, Miguel
INTRODUCTION. Intracranial arachnoids cysts are considered benign developmental anomalies that occur within the arachnoid membrane and generally contain clear and colourless fluid resembling cerebrospinal fluid. The prevalence of these cysts is higher in the first two decades of life, and the incidence is widely quoted as approximately 1% of all space-occupying intracranial lesions. Arachnoids cysts in the elderly person are a rare occurrence. We report the unusual presentation of a woman with an intraventricular arachnoid cyst treated with endoscopic technique. CASE REPORT. A 75-year-old woman presented with progressive hemiparesis of two years duration. Cranial MR imaging showed a right parieto-occipital intraventricular cyst with local mass effect and moderate dilatation of lateral ventricles. A right-sided burr hole was made and the arachnoids cyst was reached and cysto-ventricle shunting was realized. This was followed by a septum pellucidum fenestration. There were no complications during the surgery and the patient presented no symptoms at time of discharge. CONCLUSIONS. The neuroendoscopic approach to intraventricular arachnoid cysts was effective with few complications.
Singh, Pankaj Kumar; Singh, Vinay Kumar; Azam, Amir; Gupta, Sanjeev
Tarlov cysts or spinal perineurial cysts are uncommon lesions. These are mostly incidental findings on magnetic resonance imaging or myelograms. The objectives of this study were to describe Tarlov cysts of the sacral region as a potential cause for retrograde ejaculations and review available management options. Case report and literature review. A 28-year-old man presented with back pain and retrograde ejaculations resulting in infertility. After microsurgical excision of large perineurial cysts, back pain resolved, but semen quality showed only marginal improvement. Later, the couple successfully conceived by intrauterine insemination. To the best of our knowledge, this is the first reported case of Tarlov cyst associated with retrograde ejaculation and infertility. Despite being mostly asymptomatic and an incidental finding, Tarlov cyst is an important clinical entity because of its tendency to increase in size with time. Tarlov cysts of the sacral and cauda equina region may be a rare underlying cause in otherwise unexplained retrograde ejaculations and infertility. Microsurgical excision may be a good option in a select group of patients.
Khan, Saima Yunus
ABSTRACT Cleft lip and palate patients have all rights like other normal individuals, to enjoy the benefits of nourishment. Knowledge has to be there about the different feeding positions like straddle, dancer hand position along with the use of specially designed bottles and nipples. Parent's should be trained about the correct positions of feeding, in extreme of the cases in which parents are not able to follow these instructions, feeding obturators can be given. How to cite this article: Jindal MK, Khan SY. How to Feed Cleft Patient? Int J Clin Pediatr Dent 2013;6(2):100-103. PMID:25206201
Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for
Midro, A; Hubert, E; Preferansow, J; Iwaszkiewicz-Pawłowska, A
A case of TAR syndrome with bilateral cleft lip and palate is presented. Bilateral symmetric focomelia, normal thumbs among five fingers of hands, synostosis of IVth and Vth metacarpal bones and some defects of lower limbs with associated thrombocytopenia were noted. Dysmorphic facial features included hypertelorism, epicanthus, blue sclerae, broad nasal root, micrognathia, low-set ears, sparse blond hair. To our knowledge this patient represents an unusual association of TAR syndrome with orofacial clefting. A common background of TAR and Roberts/SC syndrome is suggested.
Kim, Seong-Ryong; Lee, Do-Sang; Park, Il-Young
Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.
Lin, Hung-Pin; Wang, Yi-Ping; Chen, Hsin-Ming; Cheng, Shih-Jung; Sun, Andy; Chiang, Chun-Pin
Dentigerous cyst (DC) is one of the most common developmental odontogenic cysts. This hospital-based retrospective study evaluated the clinical and histopathological features of 338 DCs in Taiwanese patients. In this study, 338 consecutive cases of DCs were collected from January 1995 to December 2009. The demographic data and clinicopathological features of these DC cases were reviewed and analyzed. The 338 DCs were taken from 332 patients (212 men and 120 women, mean age 33.0 years, range 5-83 years). There was a significant difference in the mean age between male and female patients (P < 0.05). Of the 338 DCs, 122 were found in the maxilla and 216 in the mandible. The most common site for DCs was the mandibular molar region (169 cases) and the most frequently involved tooth was the mandibular third molar (153 cases). Forty-six of the 338 DCs were found to be associated with supernumerary teeth. Microscopically, 317 cysts were lined by stratified squamous epithelium, 9 by mucoepidermoid-typed epithelium, and 12 by ciliated pseudostratified columnar epithelium. Hyaline bodies of Rushton, odontogenic epithelial rests, cholesterol clefts, foamy histiocytes, hemosiderin-laden macrophages, and dystrophic calcifications were discovered in 11, 78, 90, 33, 62 and 45 DCs, respectively. Our results indicate that DCs of Taiwanese patients have a male predominance and occur more frequently in patients between 10 and 29 years of age. The most commonly affected site for DCs is the mandibular molar region and the most frequently involved tooth is the mandibular third molar. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Govil, Somya; Gupta, Vishesh; Misra, Neeta; Misra, Pradyumna
The bilateral lateral periodontal cyst is a rare nasological entity, which despite clinical and radiological presentation is being diagnosed by histological characteristics. It is asymptomatic in nature and is observed in routine radiography. The aim and objective of this article is to present a rare case of bilateral lateral periodontal cyst in a 14-year-old child. The clinical and radiographical findings, along with its management have been discussed. Enucleation of bilateral cyst without extraction of the adjacent tooth was performed. Lesion samples were sent for histopathological analysis. The histopathological analysis revealed a thin, non keratinised stratified squamous epithelium resembling reduced enamel epithelium. Epithelial plaques were also seen. A clinicopathological correlation incorporating the surgical, radiographical and gold standard histopathological findings was obtained to suggest the final diagnosis of the bilateral lateral periodontal cyst.
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Gingival cyst of newborn is an oral mucosal lesion of transient nature. Although it is very common lesion within 3 to 6 weeks of birth, it is very rare to visualize the lesion thereafter. Presented here is a case report of gingival cyst, which was visible just after 15 days of birth. Clinical diagnoses of these conditions are important in order to avoid unnecessary therapeutic procedure and provide suitable information to parents about the nature of the lesion.
ABSTRACT Gingival cyst of newborn is an oral mucosal lesion of transient nature. Although it is very common lesion within 3 to 6 weeks of birth, it is very rare to visualize the lesion thereafter. Presented here is a case report of gingival cyst, which was visible just after 15 days of birth. Clinical diagnoses of these conditions are important in order to avoid unnecessary therapeutic procedure and provide suitable information to parents about the nature of the lesion. PMID:27616865
Lai, N C; Graham, J B; Bhargava, V; Lowell, W R; Shabetai, R
Electromagnetic flow (EMF) quantification of total cardiac stroke flow is not feasible for most elasmobranchs because the vascular anatomy precludes probe placement adjacent to the heart and proximal to all afferent branchial arteries (aba). Most previous studies report a fractional cardiac flow, made with the EMF probe placed on the ventral aorta between the innominate arteries and aba 3. Estimation of total cardiac stroke flow from such data requires a flow correction factor obtained by sacrificing the fish, and carrying out a two step in situ/in vitro flow calibration procedure which is based on tenuous assumptions. Ventral aortic blood flow measurements using the EMF techniques were carried out on large blue sharks, and radiographic imaging studies of ventral aortic and branchial blood flow were done on leopard sharks to verify previously estimated fractional cardiac stroke flow correction factors. The innominate flow fraction determined for both species in these studies are similar and agree with previous estimates for elasmobranchs. EMF data for Prionace show 38% of cardiac stroke flow goes to the innominate arteries, 23% into aba 3, 12% into aba 4, and 27% into aba 5. Radiographic analyses with Triakis reveal that 32% of its cardiac stroke volume flows into the innominate arteries which is in agreement with the in situ/in vitro fractional flow estimate (33%).
HS, Charan Babu; Rai, Bhagawan Das; Nair, Manju A.; Astekar, Madhusudan S.
Simple bone cysts (SBC) are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient. PMID:24765458
Hs, Charan Babu; Rai, Bhagawan Das; Nair, Manju A; Astekar, Madhusudan S
Simple bone cysts (SBC) are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.
Ozek, C; Gundogan, H; Bilkay, U; Cankayali, R; Guner, U; Gurler, T; Songur, E
Four cases of facial cleft that fit the anatomic description of the rare Tessier no. 2 cleft, with two patients having the no. 12 cleft extending to the cranium as no. 2 clefts, are presented. In all patients, clinical expressions of the anomaly were different. Thus, diverse surgical procedures were used in all cases. These cases and review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography scan imaging to show the bony cleft route. The diagnosis and treatment plan of the no. 2 cleft as well as its cranial counterpart are discussed in this report.
Savas Erdeve, Senay; Ocal, Gonul; Berberoglu, Merih; Siklar, Zeynep; Hacihamdioglu, Bulent; Evliyaoglu, Olcay; Fitoz, Suat
Intracranial cysts (ICC) may cause a wide spectrum of endocrinological disorders. We evaluated 27 patients who were diagnosed with ICC during investigation for neuroendocrine dysfunctions and reviewed the relevant literature. The types of ICC in the patients were arachnoid cysts (n = 13); Rathke cleft cysts (n = 7); pineal cysts (n = 5); an ependymal cyst (n = 1) and a cavum septum pellucidum cyst (n = 1). The neuroendocrine dysfunctions of the patients were obesity (n = 7), isolated growth hormone deficiency (n = 6), central precocious puberty (n = 6), multiple pituitary hormone deficiency (n = 3), central diabetes insipidus (n = 1), growth hormone deficiency and central precocious puberty (n = 1), obesity and galactorrhea (n = 1), obesity and hypogonadotropic hypogonadism (n = 1) and growth hormone neurosecretory dysfunction (n = 1). Only three patients, who had arachnoid cysts, showed neurologic symptomatology. Although three patients underwent surgery, no improvements in endocrinological dysfunctions were observed. ICC should be considered when evaluating patients with endocrinological problems and patients with coincidental ICC should be recommended for follow-up.
Nalbant, Ismail; Can Sener, Nevzat; Firat, Hacer; Yeşil, Süleyman; Zengin, Kürşad; Yalcınkaya, Fatih; Imamoglu, Abdurrahim
Background and Objectives: Renal cysts have a high prevalence in the general population, and their estimated incidence increases with age. Renal cyst aspiration (usually with sclerotherapy) or open/laparoscopic decortication is a generally effective and safe method in the treatment of symptomatic simple renal cysts. The success rates of laparoscopic decortication and percutaneous aspiration-sclerotherapy were compared to assist in the decision making for the procedure. Methods: A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively. Results: Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate. Conclusion: When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy. PMID:25848184
Hiller, Andrew D; Miller, Joshua D; Zeller, John L
Acromioclavicular joint (ACJ) cysts are an uncommon and unusual sequela associated with shoulder pathophysiology. The majority of literature on ACJ cysts consists of individual case reports with no definitive literature review currently available. In addition to a comprehensive literature review, four clinical cases are presented in this report. First described by Craig (1984), a total of 41 cases have been previously reported in the literature. Of these cases, five occurred with the rotator cuff musculature intact. The remaining 36 cases of ACJ cysts occurred in patients with a complete tear/avulsion of the rotator cuff. Previous attempts at compiling a complete record of all reported cases have combined several distinct conditions into a single category. This article presents two distinct etiologies for the pathogenesis of ACJ cyst formation. In the presence of an intact rotator cuff, a Type 1 cyst can form superficially and be limited to the ACJ. Following a massive or traumatic tear of the rotator cuff, mechanical instability of the humeral head can cause a deterioration of the inferior acromioclavicular capsule (cuff tear arthropathy) and an overproduction of synovial fluid. Overtime, a "geyser" of fluid can form between the glenohumeral and the ACJ, forming a Type 2 cyst. This differentiation and categorization is essential for appropriate classification and treatment.
Dmitriev, Konstantin; Gutenko, Ievgeniia; Nadeem, Saad; Kaufman, Arie
Accurate segmentation of abdominal organs from medical images is an essential part of surgical planning and computer-aided disease diagnosis. Many existing algorithms are specialized for the segmentation of healthy organs. Cystic pancreas segmentation is especially challenging due to its low contrast boundaries, variability in shape, location and the stage of the pancreatic cancer. We present a semi-automatic segmentation algorithm for pancreata with cysts. In contrast to existing automatic segmentation approaches for healthy pancreas segmentation which are amenable to atlas/statistical shape approaches, a pancreas with cysts can have even higher variability with respect to the shape of the pancreas due to the size and shape of the cyst(s). Hence, fine results are better attained with semi-automatic steerable approaches. We use a novel combination of random walker and region growing approaches to delineate the boundaries of the pancreas and cysts with respective best Dice coefficients of 85.1% and 86.7%, and respective best volumetric overlap errors of 26.0% and 23.5%. Results show that the proposed algorithm for pancreas and pancreatic cyst segmentation is accurate and stable.
Bas, Okan; Nalbant, Ismail; Can Sener, Nevzat; Firat, Hacer; Yeşil, Süleyman; Zengin, Kürşad; Yalcınkaya, Fatih; Imamoglu, Abdurrahim
Renal cysts have a high prevalence in the general population, and their estimated incidence increases with age. Renal cyst aspiration (usually with sclerotherapy) or open/laparoscopic decortication is a generally effective and safe method in the treatment of symptomatic simple renal cysts. The success rates of laparoscopic decortication and percutaneous aspiration-sclerotherapy were compared to assist in the decision making for the procedure. A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively. Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate. When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy.
Study Design This was a retrospective study. Purpose To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. Overview of Literature Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. Methods Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. Results All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. Conclusions Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts. PMID:26949457
Epidermoid cysts are lesions, which form as a result of implantation of the epidermis in the layers of the dermis or the mucous membrane. The lesions are rare in adults with 7% occurring in the head and neck area and most often located in the submental region. In children population submental epidermoid cysts are extremely rare. The differential diagnosis of the lesions is necessary as it affects the choice of treatment methods. Among the pathological conditions occurring in that region, salivary retention cyst (ranula), thyroglossal duct cyst, vascular lymphatic malformation (cystic hygroma), median neck cyst, lymphadenopathy, thyroid gland tumor, laryngeal cyst, epidermoid and dermoid cysts, submental abscess, sialolithiasis and salivary gland inflammation should be considered. The authors of the present report demonstrate two cases of submental epidermoid cysts in children. Differential diagnosis in case of suspected submental epidermoid cyst in a child with proposed clinical practice and literature review is provided.
Gallagher, Emily R; Collett, Brent R; Barron, Sheila; Romitti, Paul; Ansley, Timothy; Wehby, George L
Children with isolated oral clefts have lower academic performance when compared with unaffected peers, yet few studies have examined specific attributes of clefts that may modify this risk. Oral clefts have nonrandom laterality, with left-sided clefts being more common than right-sided clefts, a pattern that may be genetically or environmentally influenced. The objective of this study was to evaluate the association between cleft laterality and academic achievement in a population-based sample of children with and without isolated oral clefts. The study included 292 children with isolated unilateral cleft lip with or without cleft palate identified by using the Iowa Registry for Congenital and Inherited Disorders matched with 908 unaffected classmates. This group provided 1953 child-grade observations for cases and 6829 for classmates. Academic achievement was evaluated by using high-quality standardized test data on multiple academic domains as well as use of special education. We found that children with right-sided clefts had similar achievement scores and usage of special education services compared with their unaffected classmates. Children with left-sided clefts had lower reading scores than children with right-sided clefts by nearly 7 percentiles (P < .05). They also had lower scores on all evaluated domains by 4 to 6 percentiles and greater use of special education services by 6 percentage points than their classmates. Children with left-sided clefts had poorer academic performance than their classmates or children with right-sided clefts, who showed similar academic achievement compared with their unaffected classmates. Copyright © 2017 by the American Academy of Pediatrics.
Baginski, Frank; Brakke, Kenneth
The geometry of a large axisymmetric balloon with positive differential pressure, such as a sphere, leads to very high film stresses. These stresses can be significantly reduced by using a tendon re-enforced lobed pumpkin-like shape. A number of schemes have been proposed to achieve a cyclically symmetric pumpkin shape, including the constant bulge angle (CBA) design, the constant bulge radius (CBR) design, CBA/CBR hybrids, and NASA’s recent constant stress (CS) design. Utilizing a hybrid CBA/CBR pumpkin design, Flight 555-NT in June 2006 formed an S-cleft and was unable to fully deploy. In order to better understand the S-cleft phenomenon, a series of inflation tests involving four 27-m diameter 200-gore pumpkin balloons were conducted in 2007. One of the test vehicles was a 1/3-scale mockup of the Flight 555-NT balloon. Using an inflation procedure intended to mimic ascent, the 1/3-scale mockup developed an S-cleft feature strikingly similar to the one observed in Flight 555-NT. Our analysis of the 1/3-scale mockup found it to be unstable. We compute asymmetric equilibrium configurations of this balloon, including shapes with an S-cleft feature.
Prabhu, Sudeendra; Krishnapillai, Rekha; Jose, Maji; Prabhu, Vishnudas
The cleft anomaly may be more ancient than the man himself. It is one of the most common developmental malformations reported in the literature. There are number of intriguing theories regarding its etiopathogenesis, each of which has some evidence in its favor. This review highlights all the genetic and environmental etiologic factors and focuses on its pathogenesis. PMID:22923895
Kahilogullari, Gokmen; Tuna, Hakan; Aydin, Zafer; Colpan, Efkan; Egemen, Nihat
Spinal hydatid cysts account for 1% of all cases of hydatid disease; primary intradural hydatid cysts are uncommon. We present a case of pathologically confirmed intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. The patient presented with back pain, paraparesis, and weakness. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after surgical removal. To our knowledge, this is the 25th case of hydatid cyst at an intradural extramedullary location reported in the literature.
Gelal, Fazıl; Gurkan, Gokhan; Feran, Hamit
Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology. PMID:26962426
Singal, Rikki; Gupta, Samita; Singh, Bir
Retroperitoneal mesenteric cyst is a rare entity among the other mesenteric cysts and intra-abdominal tumours. A 42-year-old woman reported with pain abdomen off and on since one month. There were no other complaints. On ultrasonography a mesenteric cyst was diagnosed. Surgery was planned which revealed a retroperitoneal mesenteric cyst. Enucleation of the cyst was done. In follow-up of 6 months patient is asymptomatic. We are reporting a rarely reported retroperitoneal mesenteric cyst in the mesentery of the descending colon or sigmoid.
Singh, Arun Kumar; Nandini, R.
Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM) too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it's management both at the time of cleft lip repair and also secondarily
Cleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described. PMID:19884664
Czubalski, Andrzej; Barwijuk, Andrzej; Radiukiewicz, Grzegorz
Mesenteric cystic tumors are very rare. They may simulate the ovarian cysts. We report a case of a 38 year-old woman with large cystic tumor suggesting ovarian cyst. The patient was operated on and we found that genital organs were normal. Besides there was a large cyst of small intestine mesentery with 10 liters of clear fluid. The cyst was removed. Histological material showed mucinous cystadenoma.
Farrell, A P; Steffensen, J F
Experimental data are available for the oxygen cost of the branchial and cardiac pumps in fish. These data were used to theoretically analyze the relative oxygen cost of these pumps during rest and swimming in rainbow troutSalmo gairdneri. Efficiency of the heart increases with activity and so the relative oxygen cost of the cardiac pumps decreased from 4.6% at rest to 1.9% at the critical swimming speed. The relative oxygen cost of the branchial pump is significant in the resting and slowly swimming fish, being 10 to 15% of total oxygen uptake. However, when swimming trout switch to a ram mode of ventilation, a considerable saving in oxygen cost is accrued by switching the cost of ventilation from the branchial to the tail musculature. Thus, the relative oxygen cost of the branchial and cardiac pumps actually decreases at critical swimming speed compared to rest and therefore is unlikely to be a major limiting factor in maximum oxygen delivery to the tissues.
Abstract Tunicates have high capacities for regeneration but the underlying mechanisms and their relationship to life cycle progression are not well understood. Here we investigate the regeneration of distal structures in the ascidian tunicate Ciona intestinalis. Analysis of regenerative potential along the proximal−distal body axis indicated that distal organs, such as the siphons, their pigmented sensory organs, and the neural complex, could only be replaced from body fragments containing the branchial sac. Distal regeneration involves the formation of a blastema composed of cells that undergo cell proliferation prior to differentiation and cells that differentiate without cell proliferation. Both cell types originate in the branchial sac and appear in the blastema at different times after distal injury. Whereas the branchial sac stem cells are present in young animals, they are depleted in old animals that have lost their regeneration capacity. Thus Ciona adults contain a population of age‐related stem cells located in the branchial sac that are a source of precursors for distal body regeneration. PMID:25893097
Rojo, M C; Blánquez, M J; González, M E
A histochemical study of the branchial area of brown trout embryos from 35 to 71 d of incubation is reported. A battery of 6 different horseradish peroxidase-labelled lectins, the PAS reaction and Alcian blue staining were used to study the distribution of carbohydrate residues in glycoconjugates along the pharyngeal and branchial epithelia. Con A and WGA reacted at every site of the branchial region thus showing the ubiquitous presence of alpha-D-mannose and N-acetyl-D-glucosamine. WGA, DBA and SBA were good markers for the hatching gland cells (HGCs) and mucous cells. Other lectins, such as PNA and UEA I, reacted only for a short time at some sites during the considered period of incubation. From 35 d until posthatching stages, a manifest strong reaction was noted both in the dorsal epithelium of branchial arches and the HGCs as shown by SBA reactivity. This may be significant with regard to the controversial origin of HGCs, which is thought to be endodermal. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:8982837
Jeffery, William R
Tunicates have high capacities for regeneration but the underlying mechanisms and their relationship to life cycle progression are not well understood. Here we investigate the regeneration of distal structures in the ascidian tunicate Ciona intestinalis. Analysis of regenerative potential along the proximal-distal body axis indicated that distal organs, such as the siphons, their pigmented sensory organs, and the neural complex, could only be replaced from body fragments containing the branchial sac. Distal regeneration involves the formation of a blastema composed of cells that undergo cell proliferation prior to differentiation and cells that differentiate without cell proliferation. Both cell types originate in the branchial sac and appear in the blastema at different times after distal injury. Whereas the branchial sac stem cells are present in young animals, they are depleted in old animals that have lost their regeneration capacity. Thus Ciona adults contain a population of age-related stem cells located in the branchial sac that are a source of precursors for distal body regeneration.
Adn, Mahmoudreza; Saikali, Stephan; Guegan, Yvon; Hamlat, Abderrahmane
Fluid filled cystic cavities are accompaniments of some cerebral gliomas. These tumoural cysts together with peritumoural vasogenic brain oedema add to the morbid effects of the gliomas in terms of mass effect and increased intracranial pressure. Although different mechanisms have been suggested as to the pathogenesis of glioma-associated cysts, it is still unclear why these cysts appear in only a limited number of cerebral gliomas while brain oedema, a probable precursor of glioma cysts, is a usual accompaniment of most gliomas. Here, the authors present a two-hit hypothesis of brain glioma cyst formation. We suggest that after the formation of vasogenic tumoural brain oedema, microvascular phenomena may lead to the formation of microcysts, which might later become confluent and grow to form macroscopic cysts. Progress in the understanding of pathogenesis of cerebral glioma cysts might set targets for treatment of brain edema and glioma cysts.
Jain, S; Dalton, M E
To study the development of chocolate cysts by serial transvaginal ultrasonographic tracking of ovarian follicles. Retrospective study. Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Sunderland, United Kingdom. We reviewed case notes of all patients who underwent laparoscopy for diathermy to endometriosis/ovarian diathermy/aspiration of ovarian cysts from 1989 to 1998. Twelve women with histories of infertility and proven chocolate cysts with documented ultrasonographic findings were included in the study. Serial ultrasonographic tracking of ovarian follicles in the cycle leading to the development of the chocolate cysts, followed by ultrasonographic tracking of cysts for 3 months and laparoscopy. Development and formation of chocolate cysts. The diagnosis of chocolate cysts was confirmed laparoscopically in all patients and histopathologically in four. Ultrasound confirmed that they had all developed from follicles. Chocolate cysts can develop from ovarian follicles.
... Fat Necrosis and Oil Cysts in the Breast Mastitis Duct Ectasia Other Non-cancerous Breast Conditions Breast ... Fat Necrosis and Oil Cysts in the Breast Mastitis Duct Ectasia Other Non-cancerous Breast Conditions Back ...
Singhal, Shipra; Negi, Gita; Chandra, Harish; Chandra, Smita; Gaur, Dushyant Singh; Rajan, Manu
Birth abnormalities like cleft lip and cleft palate account for about 1.4 per 1000 live births in India. These are seen to be associated with a high incidence of eosinophilia which delays the surgical management of these patients. The aim of this paper is to study the hematological parameters in patients of cleft lip and cleft palate. A total of 223 cases of cleft lip and cleft palate were taken up for the study. Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were studied. Anemia was found in 182/223 (81.63%) cases which was most commonly of microcytic hypochromic type. Eosinophilia was seen in 46/223 (20.60%) cases. Many cleft lip and cleft palate patients show high eosinophil counts. Absolute eosinophil count was found to be a better parameter for assessment of eosinophils.
Gill, T.S.; Pant, J.C.; Tewari, H.
Pathological manifestations causally related to pesticide poisoning have been described in both surficial and internal tissues of the fishes. Among the various organomercurials are phenyl mercuric acetate, methyl mercuric dicyanidiamide, methoxy ethyl mercuric chloride, methoxy ethyl mercuric silicate etc. Of these, the methoxy ethyl mercuric chloride (MEMC) is used in agriculture as an antifungal seed dressing, and its toxicity is primarily manifest in the Hg/sup 2 +/ ion. This report describes pathogenesis of branchial and renal lesions in the common freshwater fish, Puntius conchonius exposed chronically to sublethal levels of MEMC. Prior to this, alterations in the peripheral blood and metabolite levels in response to experimental MEMC poisoning have been demonstrated in this species.
Kanis, Margaux J; Momeni, Mazdak; Zakashansky, Konstantin
A pilonidal cyst is an epithelialized sinus tract or cyst containing hair follicles with a surrounding inflammatory reaction. It usually develops in the sacrococcygeal region with few reports of its development in the genitalia. We present a case of a periclitoral pilonidal cyst in a young woman and its management.
Rizzo, M; Dellaero, D T; Harrelson, J M; Scully, S P
Aneurysmal bone cysts are benign primary or secondary lesions that commonly arise in long bones and often before skeletal maturity. Little has been written about aneurysmal bone cysts that abut the physeal plate. The records of 15 patients with juxtaphyseal aneurysmal bone cysts were reviewed. Fourteen of the patients were referred with abnormal radiographs after evaluation for pain in the affected limb. One patient presented with abnormal radiographs after fracture about the aneurysmal bone cyst. None of the patients had evidence of growth plate disruption. The children's ages ranged from 2 to 14 years, with a mean of 9.8 years. There were 10 boys and five girls. Lesion locations included: six in the proximal tibia, three in the distal fibula, two in the distal tibia, two in the proximal femur, one in the distal femur, and one in the distal radius. All of the lesions abutted the physeal plate and fell into one of the types in Campanacci's classification of juxtaphyseal aneurysmal bone cysts. Three lesions were classified as Type 1, eight were Type 2, and four were Type 3. This study included no cases of Type 4 or 5 lesions. Treatment of all lesions consisted of excision, curettage, and bone grafting with care taken to preserve the growth plate. Adjunctive cauterization was performed in two cases. There were no incidences of postoperative physeal plate arrest. Overgrowth of the fibula occurred in one patient. Three patients experienced recurrent lesions. One of the children underwent repeat curettage and bone grafting with no additional recurrence. In the other two children with recurrence, the lesion had grown away from the physeal plate while remaining static in size and asymptomatic. Based on this study, juxtaphyseal aneurysmal bone cysts may be treated satisfactorily with intralesional surgery and bone grafting with expectation of normal physeal growth.
Allmon, Elizabeth B.; Esbaugh, Andrew J.
Anthropogenic CO2 is expected to drive ocean pCO2 above 1,000 μatm by 2100 - inducing respiratory acidosis in fish that must be corrected through branchial ion transport. This study examined the time course and plasticity of branchial metabolic compensation in response to varying levels of CO2 in an estuarine fish, the red drum, which regularly encounters elevated CO2 and may therefore have intrinsic resilience. Under control conditions fish exhibited net base excretion; however, CO2 exposure resulted in a dose dependent increase in acid excretion during the initial 2 h. This returned to baseline levels during the second 2 h interval for exposures up to 5,000 μatm, but remained elevated for exposures above 15,000 μatm. Plasticity was assessed via gene expression in three CO2 treatments: environmentally realistic 1,000 and 6,000 μatm exposures, and a proof-of-principle 30,000 μatm exposure. Few differences were observed at 1,000 or 6,000 μatm however, 30,000 μatm stimulated widespread up-regulation. Translocation of V-type ATPase after 1 h of exposure to 30,000 μatm was also assessed; however, no evidence of translocation was found. These results indicate that red drum can quickly compensate to environmentally relevant acid-base disturbances using baseline cellular machinery, yet are capable of plasticity in response to extreme acid-base challenges.
Allmon, Elizabeth B.; Esbaugh, Andrew J.
Anthropogenic CO2 is expected to drive ocean pCO2 above 1,000 μatm by 2100 – inducing respiratory acidosis in fish that must be corrected through branchial ion transport. This study examined the time course and plasticity of branchial metabolic compensation in response to varying levels of CO2 in an estuarine fish, the red drum, which regularly encounters elevated CO2 and may therefore have intrinsic resilience. Under control conditions fish exhibited net base excretion; however, CO2 exposure resulted in a dose dependent increase in acid excretion during the initial 2 h. This returned to baseline levels during the second 2 h interval for exposures up to 5,000 μatm, but remained elevated for exposures above 15,000 μatm. Plasticity was assessed via gene expression in three CO2 treatments: environmentally realistic 1,000 and 6,000 μatm exposures, and a proof-of-principle 30,000 μatm exposure. Few differences were observed at 1,000 or 6,000 μatm; however, 30,000 μatm stimulated widespread up-regulation. Translocation of V-type ATPase after 1 h of exposure to 30,000 μatm was also assessed; however, no evidence of translocation was found. These results indicate that red drum can quickly compensate to environmentally relevant acid-base disturbances using baseline cellular machinery, yet are capable of plasticity in response to extreme acid-base challenges. PMID:28378831
Kelly, S P; Fletcher, M; Pärt, P; Wood, C M
Techniques for the in vitro 'reconstruction' of freshwater rainbow trout branchial epithelia using the primary culture of gill cells on permeable polyethylene terephthalate cell culture filter supports are described. Representing models of the freshwater fish gill, epithelia grown by two separate techniques are composed of branchial pavement cells with or without the inclusion of mitochondria-rich (MR) cells. The generation of epithelia consisting of pavement cells only (via a method called single seeded inserts = SSI) involves an initial period of flask culture during which time MR cells, that appear unable to attach to the culture flask base, are excluded from the general cell populace. Alternately, the generation of a heterogeneous epithelia consisting of both pavement cells and MR cells (via a method called double seeded inserts = DSI) is facilitated by the direct seeding of cells into cell culture filter inserts. Critical to this second procedure is the repeat seeding of filter inserts over a two day period. Repeat seeding appears to allow MR cells to nest amongst the attached cell layer generated by the first day's seeding. The use of cell culture filter supports allows free access to both the apical and basolateral compartment of the epithelium and is ideal for experimental manipulation. Cells are grown under symmetrical conditions (apical media/basolateral media) and epithelium growth is measured as a function of transepithelial resistance (TER). When the epithelia exhibit a plateau in growth they can be subjected to asymmetrical conditions (freshwater apical/media basolateral) in order to assess gill cell function as in vivo.
Fayyaz, Ghulam Qadir; Gill, Nauman Ahmad; Ishaq, Irfan; Ganatra, Muhammad Ashraf; Mahmood, Farrakh; Kashif, Muhammad; Alam, Iftikhar; Chen, Philip Kuo-Ting; Lo, Lun-Jou; Laub, Donald Rudolph
There are many countries in the world where patients with cleft lip and palate cannot get access to specialized cleft care units. Cleft missions play an important role in providing surgical care to the areas of the world with limited resources. This article presents a model of cleft missions that can be adopted in many countries where expertise is available but resources are limited. Through proper utilization of local human resource, this type of mission can be a cost-effective and robust way of treating patients with cleft in countries with approximately 52% of the world's population. We present a case series of patients of one of our cleft missions carried out in Khairpur, Pakistan, in March 2014 over a period of 7 days. Specific details concerning the organization of mission, gathering of patients, preparation for surgery, and carrying out surgical procedures in a safe and swift manner are presented. A total of 312 patients were operated on in 7 days. There were 145 patients with cleft lip and 167 patients with cleft palate. There were 187 male and 125 female patients with mean age of 7 years. Contemporary operative techniques were utilized to repair different types of cleft lip and palate. Of 167 patients, only 16 developed fistula. A locoregional cleft team can be more effective to care for the patients with cleft in countries where surgical and other expertise can be utilized by proper organization of cleft missions on a national level.
Craniofacial defects such as cleft lip and cleft palate are among the most common of all birth defects in the United States, with one in every 600 newborns affected. Cleft lip and/or palate can occur as an isolated condition or may be one component of an inherited disease or syndrome. Dealing with the condition is an extremely difficult and…
Craniofacial defects such as cleft lip and cleft palate are among the most common of all birth defects in the United States, with one in every 600 newborns affected. Cleft lip and/or palate can occur as an isolated condition or may be one component of an inherited disease or syndrome. Dealing with the condition is an extremely difficult and…
Anderson, Jada Jean; Connor, Gregory F; Helms, Clyde A
The purpose of this study was to determine the incidence of meniscal cysts, assess the frequency of various magnetic resonance (MR) imaging characteristics, and emphasize radiographic observations not commonly reported. A total of 2,095 consecutive knee MR imaging reports from a 22 month period were retrospectively reviewed for the presence of meniscal cysts. Two musculoskeletal radiologists reviewed the cases where cysts were reported. A meniscal cyst was considered present if abnormally increased signal was identified within an enlarged meniscus (i.e., intrameniscal cyst) or if a loculated fluid-intensity lesion with a clear connection to the adjacent meniscus was identified (i.e., parameniscal cyst). Presence or absence of a meniscal tear, intrameniscal and parameniscal signal intensity, patient age, sex, location of meniscal cyst, presence of discoid meniscus, and size of the parameniscal cyst component were recorded. All knee imaging examinations were performed on a 1.5T MR unit. Imaging findings were correlated with arthroscopic reports when available. A total of 167 cases (8.0%) of meniscal cysts were diagnosed in 161 patients. Of the 167 cysts, 69 (41.3%) were located in the lateral meniscus and 98 (58.7%) in the medial meniscus. In 6 patients (3.7%), meniscal cysts were present in both menisci of the same knee. Twelve (7.2%) meniscal cysts were associated with discoid menisci. Ninety-seven (57.8%) meniscal cysts were associated with meniscal tears. Of the total number of meniscal cysts, 104 (62.3%) had a parameniscal cyst. An isolated intrameniscal cyst was present in 63 (37.7%) cases. One hundred (96%) of the parameniscal cyst components were isointense to fluid on T2-weighted FSE images. All cysts exhibited abnormal intrameniscal signal. Only 14 (8.4%) of the intrameniscal components were isointense to fluid on T2-weighted FSE images. The arthroscopic reports of 88 of the 161 (54.7%) patients were available for review and correlation. A tear extending to
Butali, A; Adeyemo, W.L; Mossey, P.A; Olasoji, H.O; Onah, I.I; Adebola, A; Efunkoya; Akintububo, A; James, O; Adeosun, O.O; Ogunlewe, M.O; Ladeinde, A.L; Mofikoya, B.O; Adeyemi, M.O; Ekhaguere, O.A; Emeka, C; A MBChB, Awoyale T.
Orofacial clefts (OFC) are the most common malformations of the head and neck. In Africa, OFC is under-ascertained with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study “NigeriaCRAN” was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes and; studies into etiology and prevention. We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and gender using the Fisher’s exact test. A total of 2197 cases were identified during the study period with an estimated prevalence rate of 0.5/1000. Of the total number of OFC, 53.3% are males and 47%.7 are females. There was a significant difference (p=0.0001) between unilateral left clefts and unilateral right clefts and; significant difference (p=0.0001) between bilateral clefts and either clefts on the left or right side. A significant gender difference (p=0.03) with more females than males was also observed for CP. A total of 103 (4.7 %) associated anomalies were identified, nine syndromic cleft cases and 10.4 % of the total number of clefts individuals have an affected relative. The significant difference between unilateral clefts and gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including OFC. PMID:23557093
Cleft lip and/or palate provides an ideal, albeit complex, model for the study of human developmental anomalies. Clefting disorders show a mix of well-defined syndromic causes (many with single-gene or environmental etiologies) coupled with their more common presentation in the nonsyndromic form. This summary presents some insight into the genetic causes of, etiology of and animal models for cleft lip and/or palate. 79 refs.
Walls, T J; Purohit, D P; Aji, W S; Schofield, I S; Barwick, D D
The case of a 40-year-old woman with increasing ataxia is described. Although the clinical presentation and evoked response studies raised the possibility of multiple sclerosis, further investigation revealed multiple cystic intracranial lesions. Surgical excision of one of the lesions relieved the patient's symptoms. Histological examination revealed that this was an enterogenous cyst. Although single cysts of this type have rarely been reported occurring in the posterior cranial fossa, the occurrence of multiple lesions, some in the supratentorial compartment, appears to be unique. Images PMID:3701354
Misra, Satya Ranjan; Priyadarshini, Smita; Pati, Abhishek Ranjan; Bhuyan, Sanat Kumar; Panigrahi, Rajat G
Children may be born with birth defects, the most common being oro-facial clefts and fissural cysts. A well circumscribed pedunculated soft tissue growth that occurs congenitally is known as congenital epulis of the newborn or 'Neuman's Tumour' as described in the literature. It is a rare lesion and the diagnosis has to be confirmed histologically. We present a rare case of a 7-year-old child with a congenital growth in the pre-maxillary region of the anterior hard palate clinically diagnosed as congenital epulis however, histologically confirmed as a mucous retention cyst. An elaborate clinical differential diagnosis is discussed. The anterior hard palate is devoid of salivary glands and the presence of a mucous retention cyst in the area is suggestive of ectopic salivary gland tissue and in a child manifesting at birth is probably the first case to be reported in the English literature.
Sehgal, Nidhi; Priyadarshi, Vinod
Kidney is one of the most common sites for the cyst formation in the body, and the management of simple cysts is required entirely for its symptoms and complications. Surgical decortication is an established treatment for a large and symptomatic simple renal cyst. On the other hand, hydatid cysts of the kidney are usually multiloculated complex or calcified cysts and are quite rare. Their surgical treatment also differs and requires complete excision with pericystectomy or partial/complete nephrectomy depending upon residual functional parenchyma, using extreme caution to avoid spillage, recurrence or development of severe anaphylactic shock. A simple cyst harboring a hydatid cyst is highly uncommon and quite dangerous; as if not diagnosed preoperatively, it can create huge trouble for both the patient and the operating surgeon which happened in the present case. PMID:28794599
Sehgal, Nidhi; Priyadarshi, Vinod
Kidney is one of the most common sites for the cyst formation in the body, and the management of simple cysts is required entirely for its symptoms and complications. Surgical decortication is an established treatment for a large and symptomatic simple renal cyst. On the other hand, hydatid cysts of the kidney are usually multiloculated complex or calcified cysts and are quite rare. Their surgical treatment also differs and requires complete excision with pericystectomy or partial/complete nephrectomy depending upon residual functional parenchyma, using extreme caution to avoid spillage, recurrence or development of severe anaphylactic shock. A simple cyst harboring a hydatid cyst is highly uncommon and quite dangerous; as if not diagnosed preoperatively, it can create huge trouble for both the patient and the operating surgeon which happened in the present case.
Weiss, K M; Georges, E; Levy, B; Aguirre, A; Portilla, R J; Gaitán, C L; Leyva, E; Rodríguez, T
It has been suggested that among American Indians, as in some genetically-related Asiatic ethnic groups, incidence of cleft lip and/or cleft palate is higher than among people of Caucasian extraction. Such hypothesis, plus growing demand for services observed at a center for the surgery of cleft lip and cleft palate in Campeche state, led the authors to undertake research among the Maya residents of that region. However, neither careful review of case histories nor field research performed in several Indian communities could confirm the hypothesis of a higher incidence among this ethnic community.
Cleft Palate; Jaw Abnormalities; Maxillofacial Abnormalities; Mouth Abnormalities; Congenital Abnormalities; Jaw Diseases; Musculoskeletal Diseases; Craniofacial Abnormalities; Musculoskeletal Abnormalities; Stomatognathic Diseases; Stomatognathic System Abnormalities
Gatti, Gian Luca; Freda, Nicola; Giacomina, Alessandro; Montemagni, Marina; Sisti, Andrea
Cleft lip and palate is the most frequent congenital craniofacial deformity. In this article, the authors describe their experience with cleft lip and palate repair. Data regarding patients presenting with primary diagnosis of cleft lip and/or palate, between 2009 and 2015, were reviewed. Details including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits were collected. Documented complications were reported. Caregivers' satisfaction was assessed with a survey. The survey used to assess satisfaction with cleft-related features was based on the cleft evaluation profile (CEP). In addition, 4 assessors used visual analog scale (VAS) to assess the aesthetic satisfaction. Seven hundred fifty-two patients with primary diagnosis of cleft lip and/or palate underwent surgical correction at "S. Chiara" Hospital, 432 (57.45%) male and 320 (42.55%) female. The most common cleft types in our study were incomplete cleft palate (152 patients) and left unilateral complete cleft lip and palate (152 patients). Associated syndromes were found in 46 patients (6.12%). Cleft lip was repaired using a modified Tennison-Randall technique when the defect was unilateral, whereas a modified Mulliken technique was used for bilateral cleft lip. Cleft palate was repaired using the Bardach technique or Von Langenbeck technique at 5 to 6 months of age. Cleft lip and palate was repaired in several surgical steps. In total, complications were reported in 81 of 752 patients (14.16%). Average fathers' satisfaction score assessed using CEP was 4.5 (lip), 4.8 (nose), 4.7 (teeth), 4.8 (bite), 4.2 (breathing), 4.6 (profile). Average mothers' satisfaction score assessed using CEP was 4.3 (lip), 4.6 (nose), 4.4 (teeth), 4.5 (bite), 4.1 (breathing), 4.4 (profile). Average level of aesthetic satisfaction, assessed using VAS, was 8.7 (fathers), 8.1 (mothers), 7.9 (lay person), and 8.0 (senior cleft surgeon). The multidisciplinary management of children with
Jayaram, Rahul; Huppa, Christoph
Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.
Background: Long term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with oro facial clefts. Aim: The aim of this study was to assess and compare the periodontal status of patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) reporting to a hospital in Chennai, India. Materials and Methods: The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: patients with cleft lip (CL), Group 2: subjects with cleft palate (CP) and Group 3: subjects with cleft lip alveolus and palate (CLAP). Community Periodontal Index for Treatment needs CPITN Index was recorded. Results: Among the 80 study subjects, 51 (63.8%) were males and 29 (36.2%) were females. Among the 26 study subjects with cleft lip, 10 (38.5%) had healthy periodontium, 4 (15.4%) had bleeding on probing and 12 (46.1%) had calculus. Mean number of sextants coded for healthy and bleeding was maximum among the subjects with cleft palate. Mean number of sextants coded for calculus was maximum among the subjects with cleft lip alveolus and palate. Prevalence of periodontal disease is high among patients with cleft lip, alveolus and palate (35%) than in Cleft lip (32.5%) and Cleft Palate (32.5%). Conclusion: Gingivitis and Calculus is predominantly high in patients with Cleft Palate and Cleft Lip respectively. PMID:25954706
Nagappan, N; John, Joseph
Long term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with oro facial clefts. The aim of this study was to assess and compare the periodontal status of patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) reporting to a hospital in Chennai, India. The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: patients with cleft lip (CL), Group 2: subjects with cleft palate (CP) and Group 3: subjects with cleft lip alveolus and palate (CLAP). Community Periodontal Index for Treatment needs CPITN Index was recorded. Among the 80 study subjects, 51 (63.8%) were males and 29 (36.2%) were females. Among the 26 study subjects with cleft lip, 10 (38.5%) had healthy periodontium, 4 (15.4%) had bleeding on probing and 12 (46.1%) had calculus. Mean number of sextants coded for healthy and bleeding was maximum among the subjects with cleft palate. Mean number of sextants coded for calculus was maximum among the subjects with cleft lip alveolus and palate. Prevalence of periodontal disease is high among patients with cleft lip, alveolus and palate (35%) than in Cleft lip (32.5%) and Cleft Palate (32.5%). Gingivitis and Calculus is predominantly high in patients with Cleft Palate and Cleft Lip respectively.
Kısaoğlu, Abdullah; Özoğul, Bünyami; Atamanalp, Sabri Selçuk; Pirimoğlu, Berhan; Aydınlı, Bülent; Korkut, Ercan
Isolated pancreatic hydatid cysts are a rare parasitic disease even in endemic areas. It is difficult to discriminate primary pancreatic hydatid cysts from other cystic and solid lesions of the pancreas. This is a case report of an incidental isolated pancreatic hydatid cyst. A heterogeneous cystic lesion in the body of the pancreas was identified on magnetic resonance imaging of a patient previously diagnosed patient with cholelithiasis, and because of the malignant possibility of the lesion, splenectomy with distal pancreatectomy and cholecystectomy was performed. The histopathologic diagnosis was reported as a hydatid cyst. Pancreatic hydatid cysts should be kept in mind in the differential diagnosis of pancreatic pseudocysts and cystic malignancies.
Sajko, Tomislav; Kovać, Damir; Kudelić, Nenad; Kovac, Lana
Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.
Chbicheb, S; Bennani, A; Taleb, B; Wady, W El
The botryoid odontogenic cyst (BOC) is a developmental cyst of odontogenic epithelial origin considered as a rare multilocular variety of lateral periodontal cyst (WHO 1992). This cystic lesion site is in the periodontal space of vital teeth. A 21-year-old woman consulted for a swelling of the anterior maxillary region. The clinical examination revealed bucal swelling extending from the left central incisor to the first left premolar. The mucosa was normal. The adjacent teeth were vital. X-ray revealed a bilocular radiolucency extending between the roots of teeth 21 and 24. The lesion was enucleated, under local anaesthesia via a vestibular approach. Histology was typical of a BOC with cystic spaces lined by squamous epithelium with thickening and clear cells. Forty-eight months after surgery, there was sign of recurrence. BOC is known to be a recurrent odontogenic cyst. Several cases of multiple recurrences have been reported up to nine years after the initial surgery. Long-term follow-up is thus mandatory.
Lee, Jessica; Darcy, Michael
Renal cysts are a common imaging finding. Although most cysts never have symptoms, some cause pain, collecting system compression, hematuria, hypertension, and secondary infection. The mere presence of a cyst is not an indication for intervention, but treatment may be indicated in symptomatic patients or those with secondary obstruction. Urinomas generally are a contained collection of urine outside of the normal pathways where urine travels. As such, urinomas can arise anywhere from the upper abdomen down into the low pelvis and have a variety of etiologies. Ureteral obstruction with forniceal rupture and trauma (blunt, penetrating, or iatrogenic) are the most common causes of urinomas. When urinomas arise spontaneously, the likely cause varies with the patient's age. Blunt or penetrating trauma can cause perinephric urinomas by two mechanisms—direct disruption of the pelvis or collecting system or by degeneration of nonviable tissue. These urinomas are often perinephric, but can also occur in a subcapsular location. This review will discuss diagnosis, classification, and treatment of renal cysts and urinomas. PMID:23204636
Cauchois, R; Laccourreye, O; Bremond, D; Testud, R; Küffer, R; Monteil, J P
Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.
Grosen, Dorthe; Bille, Camilla; Petersen, Inge; Skytthe, Axel; von Bornemann Hjelmborg, Jacob; Pedersen, Jacob Krabbe; Murray, Jeffrey Clark; Christensen, Kaare
Background Small studies have indicated that twinning increases the risk of oral cleft. Methods We used data from a Danish national population-based cohort study to investigate whether twinning was associated with isolated oral cleft, and to estimate the twin probandwise concordance rate and heritability. Twins (207 affected/130,710) and singletons (7766 affected/4,798,526) born from 1936 through 2004 in Denmark were ascertained by linkage among the Danish Facial Cleft Database, the Danish Twin Registry and the Civil Registration System. We computed oral cleft prevalence and prevalence proportion ratio for twins versus singletons, stratified for three sub-phenotypes. Probandwise concordance rates and heritability for twins were estimated for two phenotypes—cleft lip with or without cleft palate (CL/P) and cleft palate (CP). Results The prevalence of oral cleft was 15.8 per 10,000 twins and 16.6 per 10,000 singletons (prevalence proportion ratio = 0.95; 95% confidence interval = 0.83 – 1.1). This prevalence was similar for monozygotic and dizygotic twins. The probandwise concordance rate was higher for CL/P for monozygotic twins than for dizygotic twins (50 % vs. 8%, respectively). A similar contrast was present for CP. Recurrence risk for both types of clefts was greater in dizygotic twins than in non-twin siblings. Heritability estimates were above 90% for both CL/P and CP. Conclusion No excess risk of oral cleft could be demonstrated for twins compared with singletons. The concordance rates and heritability estimates for both types of clefts show a strong genetic component. PMID:21423016
Zena, Lucas A; Bícego, Kênia C; da Silva, Glauber S F; Giusti, Humberto; Glass, Mogens L; Sanchez, Adriana P
The South American lungfish, Lepidosiren paradoxa inhabits seasonal environments in the Central Amazon and Paraná-Paraguay basins that undergo significant oscillations in temperature throughout the year. They rely on different gas exchange organs, such as gills and skin for aquatic gas exchange while their truly bilateral lungs are responsible for aerial gas exchange; however, there are no data available on the individual contributions of the skin and the gills to total aquatic gas exchange in L. paradoxa. Thus, in the present study we quantify the relative contributions of skin and gills on total aquatic gas exchange during warm (35°C) and cold exposure (20°C) in addition to the effects of aerial and aquatic hypercarbia on aquatic gas exchange and gill ventilation rate (fG; 25°C), respectively. Elevated temperature (35°C) caused a significant increase in the contribution of cutaneous (from 0.61±0.13 to 1.34±0.26ml. STPD.h(-1)kg(-1)) and branchial (from 0.54±0.17 to 1.73±0.53ml. STPD.h(-1)kg(-1)) gas exchange for V̇CO2 relative to the lower temperature (20°C), while V̇O2 remained relatively unchanged. L. paradoxa exhibited a greater branchial contribution in relation to total aquatic gas exchange at lower temperatures (20 and 25°C) for oxygen uptake. Aerial hypercarbia decreased branchial V̇O2 whereas branchial V̇CO2 was significantly increased. Progressive increases in aquatic hypercarbia did not affect fG. This response is in contrast to increases in pulmonary ventilation that may offset any increase in arterial partial pressure of CO2 owing to CO2 loading through the animals' branchial surface. Thus, despite their reduced contribution to total gas exchange, cutaneous and branchial gas exchange in L. paradoxa can be significantly affected by temperature and aerial hypercarbia. Copyright © 2016 Elsevier Ltd. All rights reserved.
Sharif, Faiza; Ur Rehman, Ihtesham; Muhammad, Nawshad; MacNeil, Sheila
Numerous bone and soft tissue grafting techniques are followed to repair cleft of lip and palate (CLP) defects. In addition to the gold standard surgical interventions involving the use of autogenous grafts, various allogenic and xenogenic graft materials are available for bone regeneration. In an attempt to discover minimally invasive and cost effective treatments for cleft repair, an exceptional growth in synthetic biomedical graft materials have occurred. This study gives an overview of the use of dental materials to repair cleft of lip and palate (CLP). The eligibility criteria for this review were case studies, clinical trials and retrospective studies on the use of various types of dental materials in surgical repair of cleft palate defects. Any data available on the surgical interventions to repair alveolar or palatal cleft, with natural or synthetic graft materials was included in this review. Those datasets with long term clinical follow-up results were referred to as particularly relevant. The results provide encouraging evidence in favor of dental and other related biomedical materials to fill the gaps in clefts of lip and palate. The review presents the various bones and soft tissue replacement strategies currently used, tested or explored for the repair of cleft defects. There was little available data on the use of synthetic materials in cleft repair which was a limitation of this study. In conclusion although clinical trials on the use of synthetic materials are currently underway the uses of autologous implants are the preferred treatment methods to date.
Sahoo, N.K.; Choudhary, A.K.; Srinivas, V.; Kapil Tomar
The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities. PMID:26843755
Malandrini, Alex; Balestrazzi, Angelo; Martone, Gianluca; Tosi, Gian Marco; Caporossi, Aldo
A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.
Nakae, Masanori; Sasaki, Kunio
Branchial arch muscle innervation by the glossopharyngeal (IX) and vagal (X) nerves in 10 tetraodontiform families and five outgroup taxa was examined, with special reference to muscle homologies. Basic innervation patterns and their variations were described for all muscle elements (except gill filament muscles). In the tetraodontids Takifugu poecilonotus and Canthigaster rivulata, diodontid Diodon holocanthus, and molid Mola mola, levator externus 4 was innervated by the 3rd vagal branchial trunk (BX3) in addition to BX2, owing to strong posterior expansion of the muscle. Based on nerve innervation, migrations of the muscle attachment sites (i.e., origins and insertions) were recognized in levator internus 2 (in Mola mola), obliquus dorsalis 3 (in Ostracion immaculatus and Canthigaster rivulata), and obliquus ventralis 2 (in Stephanolepis cirrhifer), muscle topologies not necessarily being indicative of homologies. Embryonic origin of the retractor dorsalis and parallel attainment of the swimbladder muscle within the order were also discussed.
Arneja, Jugpal S; Mitton, Craig
BACKGROUND: Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. OBJECTIVES: To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. METHODS: A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. RESULTS: On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. CONCLUSIONS: The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory
Yeow, Vincent K L; Lee, Seng-Teik T; Lambrecht, Thomas J; Barnett, John; Gorney, Mark; Hardjowasito, Widanto; Lemperle, Gottfried; McComb, Harold; Natsume, Nagato; Stranc, Mirek; Wilson, Libby
The International Task Force on Volunteer Cleft Missions was set up to provide a report to be presented at the Eighth International Congress of Cleft Palate and Associated Craniofacial Anomalies on September 12, 1997, in Singapore. The aim of the report was to provide data from a wide range of different international teams performing volunteer cleft missions and, thereafter, based on the collected data, to identify common goals and aims of such missions. Thirteen different groups actively participating in volunteer cleft missions worldwide were selected from the International Confederation of Plastic and Reconstructive Surgery's list of teams actively participating in volunteer cleft missions. Because of the time frame within which the committee had to work, three groups that did not respond by the stipulated deadline were omitted from the committee. The represented members and their respective institutions have undertaken more than 50 volunteer cleft missions to underdeveloped nations worldwide within the last 3 years. They have visited over 20 different countries, treating more than 3,500 patients worldwide. Based on the data collected and by consensus, the committee outlined recommendations for future volunteer cleft missions based on 1) mission objectives, 2) organization, 3) personal health and liability, 4) funding, 5) trainees in volunteer cleft missions, and 6) public relations. The task force believed that all volunteer cleft missions should have well-defined objectives, preferably with long-term plans. The task force also decided that it was impossible to achieve a successful mission without good organization and close coordination. All efforts should be made, and care taken, to ensure that there is minimal morbidity and no mortality. Finally, as ambassadors of goodwill and humanitarian aid, the participants must make every effort to understand and respect local customs and protocol. The main aims are to provide top-quality surgical service, train local
Brea-Álvarez, Beatriz; Roldán-Hidalgo, Amaya
Cystic lesions of the posterior triangle are a pathologic entity whose diagnosis is made in the first two years of life. Its presentation in adulthood is an incidental finding and the differential diagnosis includes cystic lymphangioma, lymphatic metastasis of thyroid cancer and branchial cyst. Often with the finding of a cervical lump, FNA is made before diagnostic imaging is performed, however, this procedure is not always advisable. We reviewed the cases of patients who came last year to our department with a cystic mass in this location and correlating the imaging findings with pathologic specimen. We show characteristic findings of these lesions in order to make an early diagnosis and thus to get the approach and treatment appropriate of adult patients with a cystic lesion in the posterior cervical triangle. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
Herranz González-Botas, Jesús; Padín Seara, Anselmo
To evaluate whether a nasal gel, administrated using a radial-hole inhaler, reaches the olfactory cleft and if a different administration method influences distribution. Sixteen healthy volunteers underwent a nasal endoscopy at 1 and 7minutes after the administration of a intranasal gel, with a different method in each fossa. No dye deposition was identified at the olfactory cleft, middle turbinate or middle meatus. In all cases the gel was identified at the nasal vestibule. On the right side, the second most frequent dye identification area was the inferior turbinate, with a rate of 87% at the first minute and 75% at 7 minutes. It was followed by the septum (75 and 62%) and the inferior meatus (6.2 and 12.5%). On the left side, the second most frequent stained area was the septum (18.7 and 13.5%), followed by the inferior meatus (6.5 and 65%). No inferior turbinate staining was found in the left side. There was a significant difference in the deposition rate at the septum (P<.01) and inferior turbinate (P<.001), when both administration methods were compared. No nasal gel, administrated using a radial-hole inhaler, was found at the olfactory cleft, middle turbinate or middle meatus. Gel distribution was located at the anterior and inferior portion of the nose, independent of the administration method used. Significantly different gel distribution rates were found at the septum and inferior turbinate when the 2 administration methods were compared. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Deane, E E; Kelly, S P; Woo, N Y
The effect of hormone treatment on the abundance of Na+-K+-ATPase alpha- and beta-subunit mRNA in Sparus sarba branchial tissue was investigated. Groups of seawater (33/1000) and hypo-osmotic (6/1000) acclimated fish were injected daily, with either saline, cortisol, recombinant bream growth hormone (rbGH) or ovine prolactin (oPRL). Total RNA from branchial tissue was analyzed by Northern blotting using PCR amplified Na+-K+-ATPase alpha- and beta-subunit cDNA clones. Na+-K+-ATPase alpha- and beta- subunit transcripts of 3.3kb and 2.4kb respectively, were detected and their abundance, after hormone treatment was assessed using RNA dot blots. The abundance of subunit mRNAs increased 1.4-1.9 fold, relative to controls, after cortisol treatment. The alpha:beta mRNA ratio also increased in cortisol treated seawater acclimated fish. Growth hormone treatment did not cause any significant changes in Na+-K+-ATPase subunit mRNA, whereas prolactin significantly reduced alpha-subunit mRNA levels by approximately 0.5 fold in both seawater and hypo-osmotic conditions. The data from this study add further support to the generally accepted roles that cortisol and prolactin have in the modulation of Na+-K+-ATPase activity. It can be concluded from this study that S. sarba branchial Na+-K+-ATPase subunit expression is multihormonally regulated.
Chiu, Yu-Ting; Liao, Yu-Fang
To study the relationship of cleft severity and maxillary growth in patients with unilateral cleft lip and palate. A systematic literature review. A literature survey from the PubMed database from January 1966 to December 2008 used the Medical Subject Headings terms facial growth, unilateral cleft lip palate, cephalometry, and cleft severity or cleft width. The Cleft Palate-Craniofacial Journal from 1964 to November 2008 was hand searched. Studies published as full-length articles reporting quantitative data on the relationship of cleft severity and written in English were selected. Two reviewers selected and extracted the data independently and also assessed the quality of the studies. Four studies met the selection criteria and were included in the review. All were retrospective and longitudinal. Quality analysis revealed medium to low level of the included studies. Heterogeneity of the studies prevented major conclusions about the relationship of a severe cleft and unfavorable maxillary forward growth. The review has highlighted the importance of further research. Further well-designed controlled studies and long-term studies are needed, and researchers have to consider combined assessment of cleft size and palate size. Further studies should also focus on the cleft severity at birth and at the time of palate repair.
Uchiyama, Takeshi; Yamashita, Yukari; Susami, Takafumi; Kochi, Shoko; Suzuki, Shigehiko; Takagi, Ritsuo; Tachimura, Takashi; Nakano, Yoko; Shibui, Takeo; Michi, Ken-ichi; Nishio, Juntaro; Hata, Yuiro
To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. PARTICIPANTS, PATIENTS: Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.
Sá, Jamile; Araújo, Luana; Guimarães, Laís; Maranhão, Samário; Lopes, Gabriela; Medrado, Alena; Coletta, Ricardo; Reis, Silvia
Individuals with nonsyndromic cleft lip with or without cleft palate (NSCL±P) present high frequency of dental anomalies, which may represent complicating factors for dental treatment. The aim of this study was to investigate the prevalence of dental anomalies inside cleft area in a group of Brazilians with NSCL±P. Retrospective analysis of 178 panoramic radiographs of patients aged from 12 to 45 years old and without history of tooth extraction or orthodontic treatment was performed. Association between cleft type and the prevalence of dental anomalies was assessed by chi-square test with a significance level set at p≤ 0.05. Dental anomalies were found in 88.2% (n=157) of the patients. Tooth agenesis (47.1%), giroversion (20%) and microdontia (15.5%) were the most common anomalies. Individuals with unilateral complete cleft lip and palate (CLP, p<0.0001), bilateral complete CLP (p=0.0002) and bilateral incomplete CLP (p< 0.0001) were more affected by tooth agenesis than individuals with other cleft types. The maxillary lateral incisors were the most affected teeth (p<0.0001). The present study revealed a high frequency of dental anomalies inside cleft region in NSCL±P patients, and further demonstrated that patients with unilateral complete CLP and bilateral incomplete CLP were frequently more affected by dental anomalies. Moreover, our results demonstrate that dental anomalies should be considered during dental treatment planning of individuals affected by NSCL±P.
Burt, T B; MacCarter, D K; Gelman, M I; Samuelson, C O
Although synovial cysts are most commonly associated with rheumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when popliteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae include pain, paresthesia, sensory loss, and muscle weakness or atrophy. When synovial cysts occur as mass lesions they may mimic popliteal aneurysms or hematomas, adenopathy, tumors or even inguinal hernias. Cutaneous joint fistulas, septic arthritis or osteomyelitis, and spinal cord and bladder compression are examples of other infrequent complications. Awareness of the heterogeneous manifestations of synovial cysts may enable clinicians to avoid unnecessary diagnostic studies and delay in appropriate management. Arthrography remains the definitive diagnostic procedure of choice, although ultrasound testing may be useful.
García-Conde, Mario; Martín-Viota, Lucia
There is still great controversy surrounding the origin of the arachnoid cyst. The most accepted theory in the case of congenital cysts explains how they are formed from an anomalous development of the arachnoid membrane, which is unfolded allowing the accumulation of cerebrospinal fluid inside and creating a cyst. This theory seems to explain the origin of convexity and sylvian cistern arachnoid cysts, whereas those in other locations might be due to other mechanisms. In the anatomopathological analysis, the arachnoid cyst wall can be seen as having few differences from normal, although thickened due to an increase quantity of collagenous material. A description of the embryological development of the arachnoid layer and cyst formation is presented, describing the main anatomopathological findings.
Doucette-Preville, Stephane; Tamm, Alexander; Khetani, Justin; Wright, Erin; Emery, Derek
Pathologic dilatation of the maxillary sinus by air is a rare condition with unclear etiology. We present a case of a 17 year old male with a maxillary air cyst diagnosed by computed tomography. The CT demonstrated air-filled expansion of the maxillary sinus beyond the normal anatomical limits with associated cortical bone thinning. The case report highlights the pathognomonic computed tomography findings of this rare entity and discusses the perplexing nomenclature, proposed etiologies and various treatment options.
Montiel-Jarquín, José Alvaro; Romero-Morales, Luis Enrique; Enríquez-Adalid, Ramiro Martín; Mendoza-García, Valentín Aurelio; Reyes-Páramo, Pedro; López-Colomo, Aurelio
Mesenteric cysts are lesions that appear very rare. Its incidence ranges from 1:20,000 in children and 1:100,000 in adults. Their clinical manifestations are atypical and they include abdominal pain, vomit, tumor and complications from hemorrhage, peritonitis when there is a rupture of infected cyst, intestinal occlusion, renal failure, volvulus and malignant transformation. We present a case of mesenteric cyst, located in the mesoappendix with slight vascular compromise and chronic symptoms, its treatment and evolution.
Calvo Boizas, E; Sancipriano Hernández, J A; Diego Pérez, C; Rodríguez Gutiérrez, A; Martínez-Alegría López, J; Gómez Toranzo, F
Cysts in the nasal septum are unusual, and the presence of a dental cyst is even rarer. A cyst of dental origin was produced by dental root fracture in the nasal septum. The differential diagnosis and management are discussed.
1. The gill fluxes of various non-electrolytes were measured in fresh-water- and sea-water-adapted trout (Salmo gairdneri). The studies were performed in vitro with a 'perfused-head' preparation. 2. The results allow one to specify different transepithelial pathways according to the physico-chemical characteristics of the permeant molecules: (1) for hydrophilic the physico-chemical characteristics of the permeant molecules: (1) for hydrophilic and lipophilic molecules of small molecular radius, a transcellular pathway in the respiratory cells of the secondary lamellae, (2) for hexose, all paracellular pathways in the gill epithelium, and (3) for hexose polymers (inulin, dextran), a transcellular pathway in the chloride cells of the primary lamellae. 3. The selectivity of the respiratory cells as a function of the liposolubility of the molecules tested is low. The decrease of this selectivity in the course of salt-water adaptation taken together with the modification of lipid composition of membranes and the effect of adrenaline on the branchial permeability suggests that non-electrolytes diffuse through a lipid phase able to form hydrogen bonds. 4. The high permeability of gills to hexose polymers of high molecular weight suggests a vesicular transport, especially in fish adapted to fresh water. PMID:7108794
Depew, M J; Liu, J K; Long, J E; Presley, R; Meneses, J J; Pedersen, R A; Rubenstein, J L
We report the generation and analysis of mice homozygous for a targeted deletion of the Dlx5 homeobox gene. Dlx5 mutant mice have multiple defects in craniofacial structures, including their ears, noses, mandibles and calvaria, and die shortly after birth. A subset (28%) exhibit exencephaly. Ectodermal expression of Dlx5 is required for the development of olfactory and otic placode-derived epithelia and surrounding capsules. The nasal capsules are hypoplastic (e.g. lacking turbinates) and, in most cases, the right side is more severely affected than the left. Dorsal otic vesicle derivatives (e. g. semicircular canals and endolymphatic duct) and the surrounding capsule, are more severely affected than ventral (cochlear) structures. Dlx5 is also required in mandibular arch ectomesenchyme, as the proximal mandibular arch skeleton is dysmorphic. Dlx5 may control craniofacial development in part through the regulation of the goosecoid homeobox gene. goosecoid expression is greatly reduced in Dlx5 mutants, and both goosecoid and Dlx5 mutants share a number of similar craniofacial malformations. Dlx5 may perform a general role in skeletal differentiation, as exemplified by hypomineralization within the calvaria. The distinct focal defects within the branchial arches of the Dlx1, Dlx2 and Dlx5 mutants, along with the nested expression of their RNAs, support a model in which these genes have both redundant and unique functions in the regulation of regional patterning of the craniofacial ectomesenchyme.
Amin, Shilu; Donaldson, Ian J.; Zannino, Denise A.; Hensman, James; Rattray, Magnus; Losa, Marta; Spitz, François; Ladam, Franck; Sagerström, Charles; Bobola, Nicoletta
Summary Hox transcription factors (TFs) are essential for vertebrate development, but how these evolutionary conserved proteins function in vivo remains unclear. Because Hox proteins have notoriously low binding specificity, they are believed to bind with cofactors, mainly homeodomain TFs Pbx and Meis, to select their specific targets. We mapped binding of Meis, Pbx, and Hoxa2 in the branchial arches, a series of segments in the developing vertebrate head. Meis occupancy is largely similar in Hox-positive and -negative arches. Hoxa2, which specifies second arch (IIBA) identity, recognizes a subset of Meis prebound sites that contain Hox motifs. Importantly, at these sites Meis binding is strongly increased. This enhanced Meis binding coincides with active enhancers, which are linked to genes highly expressed in the IIBA and regulated by Hoxa2. These findings show that Hoxa2 operates as a tissue-specific cofactor, enhancing Meis binding to specific sites that provide the IIBA with its anatomical identity. PMID:25640223
Goanvec, Christelle; Poirier, Elisabeth; Le-Floch, Stéphane; Theron, Michaël
This study is an attempt to go further in the comprehension of the effects of heavy fuel oil in the context of an accidental oil spill at sea. It focuses on the link between morphological and functional impacts of realistic doses of the dissolved fraction of a heavy fuel oil on fish gills. Juvenile turbot, Scophthalmus maximus were exposed to the dissolved fraction of a heavy fuel oil for 5 days and then placed 30 days in clean sea water for recovery. During the contamination period, the concentration of the 16 US EPA priority poly-aromatic hydrocarbons showed small variations around a mean value of 321.0 ± 9.1 ng l⁻¹ (mean ± SEM). The contamination induced a 64% increase in hepatic cytochrome P 450 1A (Western blot analysis). Osmolality, [Na⁺] and [Cl⁻] rapidly and significantly increased (by 14, 23 and 28% respectively) and slowly decreased to normal levels during the recovery period. At the same time, branchial histology showed decreases in the number of mucocytes (by 30%) and of chloride cells (by 95%) in the interlamellar epithelium. Therefore, it is suggested that the osmotic imbalance observed after the 5 days of exposure to the dissolved fraction of the heavy fuel oil is the consequence of the structural alteration of the gills i.e, the strong reduction of ionocyte numbers.
Wheatly, M G
Crustaceans serve as an ideal model for the study of calcium homeostasis due to their natural molting cycle. Demineralization and remineralization of the calcified cuticle is accompanied by bidirectional Ca transfer across the primary Ca transporting epithelia: gills, antennal gland (kidney), digestive system, and cuticular hypodermis. The review will demonstrate how a continuum of crustaceans can be used as a paradigm for the evolution of Ca transport mechanisms. Generally speaking, aquatic crustaceans rely primarily on branchial Ca uptake and accordingly are affected by water Ca content; terrestrial crustaceans rely on intake of dietary Ca across the digestive epithelium. Synchrony of mineralization at the cuticle vs. storage sites will be presented Physiological and behavioral adaptations have evolved to optimize Ca balance during the molting cycle in different Ca environments. Intracellular Ca regulation reveals common mechanisms of apical and basolateral membrane transport as well as intracellular sequestration. Regulation of cell Ca concentration will be discussed in intermolt and during periods of the molting cycle when transepithelial Ca flux is significantly elevated. Molecular characterization of the sarco-/endoplasmic reticular Ca pump in aquatic species reveals the presence of two isoforms that originate from a single gene. This gene is differentially expressed during the molting cycle. Gene expression may be regulated by a suite of hormones including ecdysone, calcitonin, and vitamin D. Perspectives for future research are presented.
Girisha, K M; Bhat, P; Adiga, P K; Pai, A H; Rai, L
Unusual facial cleft in Fryns syndrome: defect of stomodeum?: We report on a fetus with Fryns syndrome. The facial cleft was unusual. There was bilateral cleft lip with cleft palate. The intermaxillary segment was connected through the base of a mound in the midline to the lower lip. We believe this is an atypical facial cleft in Fryns syndrome and likely represents a defective stomodeum.
Pavri, Sabrina; Forrest, Christopher R
Objective : Orofacial clefts such as cleft lip, cleft palate, and cleft lip and palate are the most frequent congenital anomalies of the head and neck. The purpose of this study was to determine the current demographics for orofacial clefts in Canada. Methods : A request for data from all Canadian provinces (excluding Quebec due to incompatibilities with provincial coding systems) for the fiscal years 2002-2003 to 2007-2008 was submitted to the Canadian Institute for Health Information. Variables evaluated included gender, cleft type, gestational age, birth weight, income quintile, and institution health region. Results : Over the period studied, the prevalence of orofacial clefts ranged from 11.0 to 15.3 per 10,000 live births (1 in 654 to 1 in 909 live births). The distribution of cleft types for live births with orofacial clefts was 17% for cleft lip, 41% for cleft palate, and 42% for cleft lip and palate, of which cleft lip and cleft lip and palate were male dominant (62% and 66% male, respectively) and cleft palate was female dominant (56% female). Saskatchewan and Manitoba had significantly higher cleft birthrates (P < .05) compared with the other provinces. Birth weight and gestational age (but not income quintile) were significantly (P < .0001) lower for newborns with orofacial clefting compared with those with no cleft. Conclusions : Canada has one of the highest orofacial cleft birthrates in the world (prevalence of 12.7 per 10,000 live births, approximately 1 in 790 live births). This study presents an updated demographic of orofacial clefts in Canadian newborns and may be useful in predicting the burden of anticipated health care.
Weinberg, Seth M; Neiswanger, Katherine; Martin, Rick A; Mooney, Mark P; Kane, Alex A; Wenger, Sharon L; Losee, Joseph; Deleyiannis, Frederick; Ma, Lian; De Salamanca, Javier E; Czeizel, Andrew E; Marazita, Mary L
The Pittsburgh Oral-Facial Cleft study was begun in 1993 with the primary goal of identifying genes involved in nonsyndromic orofacial clefts in a variety of populations worldwide. Based on the results from a number of pilot studies and preliminary genetic analyses, a new research focus was added to the Pittsburgh Oral-Facial Cleft study in 1999: to elucidate the role that associated phenotypic features play in the familial transmission patterns of orofacial clefts in order to expand the definition of the nonsyndromic cleft phenotype. The purpose of this paper is to provide a comprehensive review of phenotypic features associated with nonsyndromic orofacial clefts. These features include fluctuating and directional asymmetry, non-right-handedness, dermatoglyphic patterns, craniofacial morphology, orbicularis oris muscle defects, dental anomalies, structural brain and vertebral anomalies, minor physical anomalies, and velopharyngeal incompetence.
Lagreze, W D; Warner, J E; Zamani, A A; Gouras, G K; Koralnik, I J; Bienfang, D C
To describe two patients with mesencephalic midline clefts and associated eye movement disorders. Case reports. The first patient developed bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, right ptosis, right fourth-nerve palsy, and right elevator palsy several years after meningitis with hydrocephalus. The second patient had bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, bilateral ptosis, limited upward gaze, and right hypertropia since childhood. In both patients, magnetic resonance imaging showed a midline cleft extending from the cerebral aqueduct into the midbrain. It is likely that the clefts affected the oculomotor nuclei and medial longitudinal fasciculi, accounting for the eye movement disorders.
Chiu, Yu-Ting; Liao, Yu-Fang; Chen, Philip Kuo-Ting
Initial cleft severity in patients with complete unilateral cleft lip and palate (UCLP) varies. This is reflected in the sizes of the cleft and the palate. The purpose of this retrospective study was to establish whether there is a relationship between cleft severity at birth and growth of the maxilla. Maxillary dental casts of 29 infants with nonsyndromic complete UCLP were used to measure the sizes of the cleft and the palate. The later growth of the maxilla was determined by using cephalometric radiographs taken at age 9. Statistical analyses were performed with multiple linear regression. The results showed a relationship between cleft area and maxillary protrusion (SNA, P <0.05). Also, there was a relationship between palate area and maxillary width (P <0.05). These data suggest that in patients with complete UCLP there is a significant relationship between initial cleft severity and maxillary growth. Patients with a small cleft area have a more protruded maxilla than do those with a large cleft area. Patients with a large palate area have a wider maxilla than those with a small palate area. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
Matute, Jorge; Lydick, Elaine A; Torres, Olga R; Owen, Karen K; Jacobsen, Kathryn H
To estimate the number of new cases of cleft lip and cleft palate in the department (state) of Alta Verapaz, Guatemala, in 2012. Cross-sectional survey of midwives from communities identified through a two-stage cluster-sampling process. Midwives were asked how many babies they had delivered in the past year and how many of those newborns had various types of birth defects, as illustrated in pictures. Indigenous Mayan communities in rural north-central Guatemala. Midwives (n = 129) who had delivered babies in the previous year. Reports of babies born with cleft lip and cleft palate. A 1-year prevalence rate of 18.9 per 10,000 for cleft lip and 4.7 per 10,000 for cleft palate was estimated for Alta Verapaz. None of the cases of cleft lip also had cleft palate. The indigenous communities in north-central Guatemala might have a relatively high cleft lip prevalence rate compared with the global average.
George, Lovya; Jain, Sunil K.
Preterm infants (PIs) often require respiratory support due to surfactant deficiency. Early weaning from mechanical ventilation to noninvasive respiratory support decreases ventilation-associated irreversible lung damage. This wean is particularly challenging in PIs with cleft lip and cleft palate due to anatomical difficulties encountered in maintaining an adequate seal for positive pressure ventilation. PI with a cleft lip and palate often fail noninvasive respiratory support and require continued intubation and mechanical ventilation. We are presenting the first case report of a PI with cleft lip and palate who was managed by biphasic nasal continuous positive airway pressure. PMID:26495158
Antonarakis, Gregory S; Tompson, Bryan D; Fisher, David M
Maxillary growth in patients with cleft lip and palate is highly variable. The authors' aim was to investigate associations between preoperative cleft lip measurements and maxillary growth determined cephalometrically in patients with complete unilateral cleft lip and palate (cUCLP). Retrospective cross-sectional study. Children with cUCLP. Preoperative cleft lip measurements were made at the time of primary cheiloplasty and available for each patient. Maxillary growth was evaluated on lateral cephalometric radiographs taken prior to any orthodontic treatment and alveolar bone grafting (8.5 ± 0.7 years). The presence of associations between preoperative cleft lip measurements and cephalometric measures of maxillary growth was determined using regression analyses. In the 58 patients included in the study, the cleft lateral lip element was deficient in height in 90% and in transverse width in 81% of patients. There was an inverse correlation between cleft lateral lip height and transverse width with a β coefficient of -0.382 (P = .003). Patients with a more deficient cleft lateral lip height displayed a shorter maxillary length (β coefficient = 0.336; P = .010), a less protruded maxilla (β coefficient = .334; P = .008), and a shorter anterior maxillary height (β coefficient = 0.306; P = .020) than those with a less deficient cleft lateral lip height. Patients with cUCLP present with varying degrees of lateral lip hypoplasia. Preoperative measures of lateral lip deficiency are related to later observed deficiencies of maxillary length, protrusion, and height.
Sá, Jamile; Araújo, Luana; Guimarães, Laís; Maranhão, Samário; Lopes, Gabriela; Medrado, Alena; Coletta, Ricardo
Background Individuals with non syndromic cleft lip with or without cleft palate (NSCL±P) present high frequency of dental anomalies, which may represent complicating factors for dental treatment. The aim of this study was to investigate the prevalence of dental anomalies inside cleft area in a group of Brazilians with NSCL±P. Material and Methods Retrospective analysis of 178 panoramic radiographs of patients aged from 12 to 45 years old and without history of tooth extraction or orthodontic treatment was performed. Association between cleft type and the prevalence of dental anomalies was assessed by chi-square test with a significance level set at p≤ 0.05. Results Dental anomalies were found in 88.2% (n=157) of the patients. Tooth agenesis (47.1%), giroversion (20%) and microdontia (15.5%) were the most common anomalies. Individuals with unilateral complete cleft lip and palate (CLP, p<0.0001), bilateral complete CLP (p=0.0002) and bilateral incomplete CLP (p< 0.0001) were more affected by tooth agenesis than individuals with other cleft types. The maxillary lateral incisors were the most affected teeth (p<0.0001). Conclusions The present study revealed a high frequency of dental anomalies inside cleft region in NSCL±P patients, and further demonstrated that patients with unilateral complete CLP and bilateral incomplete CLP were frequently more affected by dental anomalies. Moreover, our results demonstrate that dental anomalies should be considered during dental treatment planning of individuals affected by NSCL±P. Key words:Nonsyndromic cleft lip with or without palate, dental anomaly, tooth agenesis, microdontia. PMID:26615505
Harrison, M. J. G.
The case histories of 14 children are described in which hydrocephalus was found on investigation to be associated with a cyst of the posterior fossa or subarachnoid cisterns. The neuroradiological and histological findings are described. The cysts are considered to be developmental in origin. Their recognition and management are discussed. Images PMID:5315217
Durán, J. A.; Cuevas, J.
We present a case of an epithelial cyst of the conjunctiva caused by the dilatation of an accessory lacrimal gland. The case is peculiar in regard to the size of the cyst and the absence of traumatic or inflammatory factors to explain the retention of fluid. Images PMID:6860616
Chen, Hou-Ping; Liu, Wen-Ying; Tang, Yun-Man; Ma, Bu-Yun; Xu, Bing; Yang, Gang; Wang, Xue-Jun
To evaluate the clinical features, diagnosis, and treatment of chylous mesenteric cysts (CMCs) in children. We analyzed retrospectively the clinical records of 10 children with a CMC, treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between 1987 and 2008. This series comprised five girls and five boys. The CMC manifested as abdominal distention (n = 9), acute abdomen (n = 8), or an asymptomatic abdominal mass (n = 1), and included five mesojejunal cysts and five mesoileal cysts. Intestinal volvulus occurred in four patients with mesoileal cysts and acute chylous effusion occurred in two patients with mesojejunal cysts. All ten children were treated surgically. The cystic content was positive for Sudan III staining and the chylous test. Chylous mesenteric cysts manifest as an abdominal mass, abdominal distention, and/or acute abdomen more often in children than in adults. The clinical presentation suggests some association with the localization of the cysts. A good prognosis can be expected with removal of the cyst and the affected intestinal segment.
Lang, E K
The edict to contain costs and meet goals imposed by DRG remuneration policies mandates the work-up of asymptomatic renal mass lesions on an outpatient basis. This proved feasible in 98 per cent of patients. The vast majority of such mass lesions (82 to 90 per cent) is diagnosed with acceptable confidence by computed tomography and sonography alone. For a shrinking group of such patients, yet still 16 to 18 per cent, guided percutaneous aspiration biopsy is necessary to affirm the diagnosis. However, this technique has been refined during recent years to incorporate the use of thin needle equipment and can now be performed on an outpatient basis without significant risk of morbidity. For diagnosing hyperdense inflammatory and infected renal cysts, guided percutaneous aspiration is recommended as the most effective method. This procedure should take precedence over surgical exploration because it can diagnose and provide pertinent bacteriologic information that may determine the course of therapy. In many instances inflammatory cysts or even silent renal abscesses are diagnosed by a percutaneous aspiration technique that is then expanded to serve therapeutic purposes such as percutaneous drainage. Even these procedures can be performed safely on an outpatient basis provided the patient is followed closely. Because complications of percutaneous aspiration procedures are extremely rare, the procedure can be used safely on an outpatient basis. The impact of magnetic resonance imaging on the diagnosis of asymptomatic space-occupying lesions of the kidney is as yet not fully determined; however, this method appears promising for diagnosing some of the refractory lesions such as hemorrhagic cysts, aneurysms, or arteriovenous malformations.
Oursin, C; Wetzel, S G; Lyrer, P; Bächli, H; Stock, K W
Intradural dermoids are rare congenital tumors representing approximately 0.05% of all intracranial lesions. These benign tumors have a typical appearance on CT and MR due to their lipid components. The complication caused by rupture are the spillage of the fatty material into the cerebrospinal fluid. We report a case of a ruptured dermoid cyst showing fat/fluid levels in both side ventricles and fatty material in the subarachnoid space on CT and MR-imaging and the follow-up over four years after incomplete resection of the tumor.
Orr, David J A; Teeling, Emma C; Puechmaille, Sébastien J; Finarelli, John A
A normal feature of the facial anatomy of many species of bat is the presence of bony discontinuities or clefts, which bear a remarkable similarity to orofacial clefts that occur in humans as a congenital pathology. These clefts occur in two forms: a midline cleft between the two premaxillae (analogous to the rare midline craniofacial clefts in humans) and bilateral paramedian clefts between the premaxilla and the maxillae (analogous to the typical cleft lip and palate in humans). Here, we describe the distribution of orofacial clefting across major bat clades, exploring the relationship of the different patterns of clefting to feeding mode, development of the vomeronasal organ, development of the nasolacrimal duct and mode of emission of the echolocation call in different bat groups. We also present the results of detailed radiographic and soft tissue dissections of representative examples of the two types of cleft. The midline cleft has arisen independently multiple times in bat phylogeny, whereas the paramedian cleft has arisen once and is a synapomorphy uniting the Rhinolophidae and Hipposideridae. In all cases examined, the bony cleft is filled in by a robust fibrous membrane, continuous with the periosteum of the margins of the cleft. In the paramedian clefts, this membrane splits to enclose the premaxilla but forms a loose fold laterally between the premaxilla and maxilla, allowing the premaxilla and nose-leaf to pivot dorsoventrally in the sagittal plane under the action of facial muscles attached to the nasal cartilages. It is possible that this is a specific adaptation for echolocation and/or aerial insectivory. Given the shared embryological location of orofacial clefts in bats and humans, it is likely that aspects of the developmental control networks that produce cleft lip and palate in humans may also be implicated in the formation of these clefts as a normal feature in some bats. A better understanding of craniofacial development in bats with and
... lip and palate Cleft lip and palate repair Review Date 5/9/2016 Updated by: David A. ... and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by ...
... or more if they are having hearing problems. Dental Problems Children with a cleft lip and palate ... improve speech and breathing, overbites/underbites, and appearance. Dental and Orthodontic Treatment Maintaining healthy teeth and preventing ...
Nagy, Krisztián; Mommaerts, Maurice Y
Our aim was to describe the postoperative management and wound care protocol after primary cleft lip closure, as it has been used in the Bruges Cleft and Craniofacial Center at the supraregional teaching hospital AZ St. Jan, Bruges, between June 1, 1991, and July 1, 2009. The postoperative management and wound care included the use of a Logan bow, long-acting local anesthetic, elbow restraints, antibiotic therapy, crust removal with normal saline solution, and a special local wound ointment that was prepared at our center. During the last 19 years, 199 unilateral and 103 bilateral cleft lip patients have been repaired. 2.6% showed postoperative infection and/or dehiscence. One percent required readmission for reoperation. In 1.6%, inflammatory reaction was treated with oral antibiotics. The specific wound dressing ointment, as it is prepared in our department, could meet the requirements of primary wound management after cleft lip closure.
Shkoukani, Mahdi A.; Chen, Michael; Vong, Angela
Orofacial clefts comprise a range of congenital deformities and are the most common head and neck congenital malformation. Clefting has significant psychological and socio- economic effects on patient quality of life and require a multidisciplinary team approach for management. The complex interplay between genetic and environmental factors play a significant role in the incidence and cause of clefting. In this review, the embryology, classification, epidemiology, and etiology of cleft lip are discussed. The primary goals of surgical repair are to restore normal function, speech development, and facial esthetics. Different techniques are employed based on surgeon expertise and the unique patient presentations. Pre-surgical orthopedics are frequently employed prior to definitive repair to improve outcomes. Long term follow up and quality of life studies are discussed. PMID:24400297
Socolofsky, M. D.; Wyss, Orville
Socolofsky, M. D. (University of Texas, Austin) and Orville Wyss. Resistance of the Azotobacter cyst. J. Bacteriol. 84:119–124. 1962—The Azotobacter cysts were found to be more resistant than the vegetative cells to various harmful agents. Studies involving ultraviolet irradiation indicated that cysts required twice as great a dosage, as correspondingly treated vegetative cells, to be 90% inactivated. The acquisition of ultraviolet resistance during the encystment process was gradual and appeared to be related to the formation of exine and intine. A slow loss of ultraviolet resistance during germination was also noted. The cysts exhibited no marked resistance to heat, although they were extremely resistant to gamma radiation, sonic treatment, and desiccation. Evidence was presented indicating that the cyst is not a bacterial endospore. The encystment process may confer a survival advantage upon the organism by coupling the low endogenous respiration rate with the ability to withstand desiccation. Images PMID:13914732
Gelabert-González, Miguel; Santín-Amo, José María; Aran-Echabe, Eduardo; García-Allut, Alfredo
Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.
Simple cysts are rare in the urinary bladder and can pose a diagnostic dilemma to both the urologist and the histopathologist. No case study was found in the database of Elsevier Science Direct, Spring-Link, or PubMed. We present two cases of subserous cyst in the bladder and discuss the diagnosis and treatment of the condition. The cystic lesion at bladder dome was detected by radiologic examination and confirmed by cystoscopy. In case 1, transurethral resection was first performed which was followed by partial cystectomy; In case 2, the cyst was removed with the urachus using laparoscopic surgery. The patients recovered uneventfully and the histopathology showed cysts in subserous layer of urinary bladder. The bladder cyst should be distinguished from urachal tumor, and laparoscopic partial cystectomy is the preferred operative procedure.
Watson, Caroline J; Nordi, Wiolene M; Esbaugh, Andrew J
Red drum, Sciaenops ocellatus, is an estuarine-dependent fish species commonly found in the Gulf of Mexico and along the coast of the southeastern United States. This economically important species has demonstrated freshwater tolerance; however, the physiological mechanisms and costs related to freshwater exposure remain poorly understood. The current study therefore investigated the physiological response of red drum using an acute freshwater transfer protocol. Plasma osmolality, Cl⁻, Mg²⁺ and Ca²⁺ were all significantly reduced by 24h post-transfer; Cl⁻ and Mg²⁺ recovered to control levels by 7days post-transfer. No effect of transfer was observed on muscle water content; however, muscle Cl⁻ was significantly reduced. Interestingly, plasma and muscle Na⁺ content was unaffected by freshwater transfer. Intestinal fluid was absent by 24h post-transfer indicating cessation of drinking. Branchial gene expression analysis showed that both CFTR and NKCC1 exhibited significant down-regulation at 8 and 24h post-transfer, respectively, although transfer had no impact on NHE2, NHE3 or Na⁺, K⁺ ATPase (NKA) activity. These general findings are supported by immunohistochemical analysis, which revealed no apparent NKCC containing cells in the gills at 7days post transfer while NKA cells localization was unaffected. The results of the current study suggest that red drum can effectively regulate Na⁺ balance upon freshwater exposure using already present Na⁺ uptake pathways while also down-regulating ion excretion mechanisms.
Mitchell, Reed T; Henry, Raymond P
Carbonic anhydrase (CA) plays an essential role as a provider of counterions for Na(+)/H(+) and Cl(-)/HCO3 (-) exchange in branchial ionic uptake processes in euryhaline crustaceans. CA activity and gene expression are low in crabs acclimated to full-strength seawater, with transfer to low salinity resulting in large-scale inductions of mRNA and subsequent enzyme activity in the posterior ion-regulating gills (e.g., G7). In the green crab Carcinus maenas, CA has been shown to be under inhibitory neuroendocrine control by a putative hormone in the x-organ-sinus gland complex (XOSG), located in the eyestalk. This study characterizes the neuroendocrine regulation of CA induction in the blue crab Callinectes sapidus, a commonly used experimental organism for crustacean osmoregulation. In crabs acclimated to full-strength seawater, eyestalk ligation (ESL) triggered a 1.8- and 100-fold increase in CA activity and mRNA, respectively. Re-injection with eyestalk homogenates abolished increases in CA activity and fractionally reduced CA gene expression. ESL also enhanced CA induction by 33% after 96 h in crabs transferred to 15 ppt salinity. Injection of eyestalk homogenates into intact crabs transferred from 35 to 15 ppt diminished by 43% the CA induction stimulated by low salinity. These results point to the presence of a repressor hormone in the eyestalk. Separate injections of medullary tissue (MT) and sinus gland (SG), two components of the eyestalk, reduced salinity-stimulated CA activity by 22% and 49%, suggesting that the putative repressor is localized to the SG. Crabs injected with SG extract harvested from crabs acclimated to 5 ppt showed no decrease in CA activity, demonstrating that the hormone is down-regulated at low salinity. Our results show the presence in the XOSG of an inhibitory compound that regulates salinity-stimulated CA induction. © 2014 Marine Biological Laboratory.
Howe, B J; Cooper, M E; Wehby, G L; Resick, J M; Nidey, N L; Valencia-Ramirez, L C; Lopez-Palacio, A M; Rivera, D; Vieira, A R; Weinberg, S M; Marazita, M L; Moreno Uribe, L M
Although children with oral clefts have a higher risk for dental anomalies when compared with the general population, prior studies have shown conflicting results regarding their dental decay risk. Also, few studies have assessed dental decay risk in unaffected relatives of children with clefts. Thus, the question of increased risk of dental decay in individuals with oral clefts or their unaffected relatives is still open for empirical investigation. This study characterizes dental decay in the largest international cohort to date of children with nonsyndromic clefts and their relatives, as compared with controls, and it addresses whether families with oral clefts have a significantly increased risk for dental decay versus the general population. A total of 3,326 subjects were included: 639 case probands, 1,549 unaffected relatives, and 1,138 controls. Decay was identified from in-person dental examinations or intraoral photographs. Case-control differences were tested with regression analysis. No significant differences were shown in percentage decayed and filled teeth and decayed teeth in the primary dentition (dft, dt) and permanent dentition (DFT, DT) in cases versus controls. In the cleft region, no significant differences were seen in primary or permanent decay (dt, DT) when compared with controls. No difference was found with regard to cleft type and percentage dft, dt, DFT, and DT in case probands. Nonsignificant differences were found in unaffected siblings and parents versus controls (primary and permanent dentitions). Collectively, these findings indicate that individuals with nonsyndromic oral clefts and their families do not have a higher dental decay risk as compared with the general population. These results suggest that either genetic or environmental factors underlying a higher susceptibility for dental anomalies do not increase caries risk or that the seemingly higher risk for dental decay associated with increased dental anomalies in case
Potvin, Éric; Beuret, Laurent; Cadrin-Girard, Jean-François; Carter, Marcelle; Roy, Sophie; Tremblay, Michel; Charron, Jean
The precise expression of the N-myc proto-oncogene is essential for normal mammalian development, whereas altered N-myc gene regulation is known to be a determinant factor in tumor formation. Using transgenic mouse embryos, we show that N-myc sequences from kb −8.7 to kb +7.2 are sufficient to reproduce the N-myc embryonic expression profile in developing branchial arches and limb buds. These sequences encompass several regulatory elements dispersed throughout the N-myc locus, including an upstream limb bud enhancer, a downstream somite enhancer, a branchial arch enhancer in the second intron, and a negative regulatory element in the first intron. N-myc expression in the limb buds is under the dominant control of the limb bud enhancer. The expression in the branchial arches necessitates the interplay of three regulatory domains. The branchial arch enhancer cooperates with the somite enhancer region to prevent an inhibitory activity contained in the first intron. The characterization of the branchial arch enhancer has revealed a specific role of the transcription factor GATA3 in the regulation of N-myc expression. Together, these data demonstrate that correct N-myc developmental expression is achieved via cooperation of multiple positive and negative regulatory elements. PMID:20855530
Vizioli, L; Cerillo, A; Falivene, R; Mottolese, C; Tedeschi, G
The AA., after having examined the various hypothesis reported in literature about the etiopathogenesis and the contrasting anatomical and pathological data concerning the arachnoid supratentorial cysts, point out the remarkable frequency of they malformative and above-all post-traumatic genesis. On the formation mechanism of this last type, they agree upon the supposition expressed by Taveras and Ransohoff in 1953. The AA., therefore, after having analysed the principal morphological and topographical aspects, pay attention to the present diagnostic possibilities, above all in radiological range, where the TAC represents, by this time, the examination of election compared with traditional assurances with means of contrast. It follows the analysis of the personal casuistry, consisting in 6 arachnoid supratentorial cysts, two of which clearly post-traumatic and two, very probably, of malformative genesis (for the coexistence of data in favour of both suppositions). The AA. draw these conclusions: the CT Scan is the only diagnostic means which permits an exact pre-operating diagnosis on the nature of the lesion; the surgical and, above all, anatomo-pathological reports assume an essential rule for an exact etiopathogenetic interpretation of the lesion examined.
Rullo, R; Festa, V M; Rullo, R; Addabbo, F; Chiodini, P; Vitale, M; Perillo, L
To examine the prevalence of different types of dental anomalies in children with nonsyndromic cleft lip, unilateral cleft lip-palate, and bilateral cleft lip-palate. A sample of 90 patients (aged 4-20 years) affected by isolated cleft lip, unilateral and bilateral cleft lip and palate was examined. Cleft patients were classified into one of three groups according to cleft type: (1) Unilateral Cleft Lip-Palate, (2) Bilateral Cleft Lip-Palate, and (3) Cleft Lip. Intraoral exams, panoramic radiographs and dental casts, were used to analyse the prevalence of the various dental anomalies included in this study. There were no statistically significant differences between patients with cleft lip, unilateral cleft lip and palate and bilateral cleft lip and palate. The congenital absence of the cleft-side lateral incisor was observed in 40% of the sample, and a total of 30% patients showed supernumerary teeth at the incisors region. Second premolar agenesis was found in 4.4% of patients, whereas in 18.9% of the sample there was an ectopic dental eruption. Lateral or central incisors rotation was noted in 31.1% of the sample, while shape anomaly, lateral incisor microdontia, and enamel hypoplasia were detected respectively in 25.6%, 5.6% and 18.9% of cleft patients. High prevalence of different dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate has been confirmed. This study, in particular, shows the presence of ectopic and rotated teeth in the cleft area.
Mokhtari, Maral; Kumar, Perikala Vijayananda
Mesenteric cysts are heterogeneous groups of lesions. Most of them are developmental cysts of lymphatic and enteric origin or cystic neoplasm such as mesothelioma or cystic teratoma. Urogenital cysts are a subcategory of developmental cysts of the mesentery. They are thought to arise from vestigial remnants of urogenital apparatus. These cysts may show evidence of mesonephric or metanephric differentiation. An 11 -year -old boy was presented with undescended testis. During preoperative work- up, an incidental cystic lesion was discovered which was attached to the ileum. Aspiration cytology of the cyst content revealed cuboidal to columnar cells; some of them were ciliated. Histologic examination showed a cyst with fibromuscular wall, lined by Mullerian type ciliated epithelium; so the diagnosis of urogenital mesenteric cyst of Mullerian type was made. Urogenital cysts are rare lesions, but they should be considered in differential diagnosis of any cystic lesion of the mesentery. Cytology could be a useful method for evaluation and revealing the nature of these cysts.
Litvinenko, Liudmila I.; Litvinenko, Aleksandr I.; Boiko, Elena G.; Kutsanov, Kirill
In Western Siberia (Russia) there are about 100 Artemia lakes with total area over 1 600 km2. Geographically these lakes are located between 51°-56°N and 61°-82°E. In general these lakes are shallow (depth less than 1.5 m), small or medium size (0.1 to 10 km2); they are chloride; their total salinity is from 40 to 250 g/L. The harvesting of cysts per year is only in 20-40 lakes. In Russia 550 tons of dry Artemia cysts (14%-18% of the world production) were harvested annually. This includes about 350 tons in the Altai region and 200 tons in other regions. During our regular 20-year study period the cyst harvest was: 95 tons in Kurgan; 65 tons in Omsk, 20 tons in Novosibirsk, 20 tons in Tyumen. Ways of increasing cyst harvest in Russia are considered in this article. During the last 30 years the harvest of cysts in Russia has increased from 7-20 to 500-600 tons. A significant influence of dryness of the year was found on productivity in selected lakes, but taken for all the lakes together, the relationship was not significant. The optimal salinity for productivity of cysts in the lakes was determined. Analysis of productivity of the lakes and the harvesting results showed that the stocks of cysts are underutilized by approximately 1.7 times.
Gagliano, Nicoletta; Carinci, Francesco; Moscheni, Claudia; Torri, Carlo; Pezzetti, Furio; Scapoli, Luca; Martinelli, Marcella; Gioia, Magda; Stabellini, Giordano
We aimed to characterize the fibroblast phenotype of patients by analyzing gene and protein expression of cleft lip and/or cleft palate fibroblasts in relation to collagen turnover and extracellular matrix remodeling. Human palatal fibroblasts were obtained from three healthy subjects without cleft lip and/or cleft palate and from three subjects with nonsyndromic cleft lip and/or cleft palate. Collagen turnover-related gene and protein expression were analyzed by real-time polymerase chain reaction, Western and dot blots, and sodium dodecyl sulfate zymography. Cleft lip and/or cleft palate fibroblasts, compared with controls, displayed a down-regulation of collagens type I and III messenger RNA (p < .0001 and p < .001, respectively) but an opposite tendency to increase protein levels. Cleft lip and/or cleft palate cells had higher lysyl hydroxylase-2b messenger RNA levels expressed in relation to collagen type I messenger RNA, down-regulated matrix metalloproteinase-1, tissue inhibitor of matrix metalloproteinase-1, and Secreted Protein Acidic and Rich in Cysteine messenger RNA (p < .0001 and p < .01, respectively). Pro-matrix metalloproteinase-1 tended to decrease, and pro-matrix metalloproteinase-2 and -9 were down-regulated (p < .01, p < .05, respectively), as was Secreted Protein Acidic and Rich in Cysteine protein expression (p < .05). Our results suggest that the cleft lip and/or cleft palate fibroblast phenotype is characterized by a tendency toward interstitial collagen deposition due to posttranslational modifications, such as decreased collagen degradation by matrix metalloproteinases and increased collagen cross-links. These findings may contribute to the knowledge of the cleft lip and/or cleft palate fibroblast phenotype and may be useful to the surgeon when considering the potential wound contraction and subsequent undesired scarring in cleft lip and/or cleft palate ocurring after the surgical closure of a cleft palate.
Tarlov, I. M.
Perineurial cysts may be responsible for clinical symptoms and a cure effected by their removal. They do not fill on initial myelography but may fill with Pantopaque some time, days or weeks, after Pantopaque has been instilled into the subarachnoid space. Perineurial cysts arise at the site of the posterior root ganglion. The cyst wall is composed of neural tissue. When initial myelography fails to reveal an adequate cause for the patient's symptoms and signs referable to the caudal nerve roots, then about a millilitre of Pantopaque should be left in the canal for delayed myelography which may later reveal a sacral perineurial cyst or, occasionally, a meningeal cyst. Meningeal diverticula occur proximal to the posterior root ganglia and usually fill on initial myelography. They are in free communication with the subarachnoid space and are rarely in my experience responsible for clinical symptoms. Meningeal diverticula and meningeal cysts appear to represent a continuum. Pantopaque left in the subarachnoid space may convert a meningeal diverticulum into an expanding symptomatic meningeal cyst, as in the case described. Many cases described as perineurial cysts represent abnormally long arachnoidal prolongations over nerve roots or meningeal diverticula. In general, neither of the latter is of pathological significance. Perineurial, like meningeal cysts and diverticula, may be asymptomatic. They should be operated upon only if they produce progressive or disabling symptoms or signs clearly attributable to them. When myelography must be done, and this should be done only as a preliminary to a probable necessary operation, then patient effort should be made to remove the Pantopaque. Images PMID:5531903
Ruibal Moldes, M; Sánchez Rodríguez-Losada, J; López García, D; Casas Agudo, V; Janeiro País, J M; González Martín, M
Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery.
Saura Rojas, J Enrique; Horcajadas Almansa, Ángel; Ros López, Bienvenido
Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations.
Basar, Omer; Brugge, William R
Our treatment approach for either symptomatic or incidentally found pancreatic cysts continues to improve. The true incidence of pancreatic cysts is not known, and pancreatic cystic neoplasms, especially intraductal papillary mucinous neoplasms, are currently most commonly diagnosed and resected. This is a result of increasing awareness, widespread availability of imaging, and better understanding of the nature of pancreatic cysts as well. Recent studies on molecular analysis and devices such as microbiopsy forceps help us better define and select the treatment approach to alleviate symptoms and to prevent malignant tumors while avoiding unnecessary surgery. Published by Elsevier Inc.
Patel, B.K.; Markivee, C.R.; George, E.A.
Although pericardial celomic or mesothelial cysts are infrequent mediastinal lesions, they represent the most common benign mass lesion of the pericardium. Most often they are located at the right cardiophrenic junction. As a rule, they are asymptomatic and are discovered incidentally on routine chest radiography. A symptomatic pericardial cyst is described in a patient with congestive cardiomyopathy, causing progressive atypical chest pain, dyspnea, and palpitation. On computer tomography (CT) and other imaging methods, the lesion simulated a cardiac mass. Thoracotomy revealed a large hemorrhagic pericardial celomic cyst compressing and displacing the heart and midmediastinal vasculature.
Gafă, R; Grandi, E; Cavazzini, L
A rare case of lymphoepithelial cyst of the pancreas is reported. Microscopically the cyst content consisted of keratinous material and the walls were lined by mature squamous epithelium surrounded by dense lymphoid tissue. Immunohistochemistry showed diffuse reactivity for CD20 and CD3 in the lymphoid tissue and uniform positivity for cytokeratins in the squamous epithelium. Although the histogenesis of lymphoepithelial cysts of the pancreas is not understood, awareness of this lesion is helpful in differentiating it from other pancreatic cystic lesions. Images PMID:9389985
Peleg, D; Yankowitz, J
The association of choroid plexus cysts with fetal aneuploidy, particularly trisomy 18, was first noted in 1986. Through the years there have been numerous reports on this subject, but no consensus has been reached with regard to chromosomal risk. In this review, we attempt to summarise published reports on second trimester choroid plexus cysts, with an emphasis on the strengths and weaknesses of each report. Based on these reports, additional malformations are a significant risk factor for aneuploidy and an indication for determination of fetal karyotype. The management of isolated choroid plexus cysts remains controversial. PMID:9678699
Lakiza, Olga; Miller, Sarah; Bunce, Ashley; Lee, Eric Myung-Jae; McCauley, David W
SoxE genes are multifunctional transcriptional regulators that play key roles in specification and differentiation of neural crest. Three members (Sox8, Sox9, Sox10) are expressed in the neural crest and are thought to modulate the expression and activity of each other. In addition to regulating the expression of other early neural crest marker genes, SoxE genes are required for development of cartilage. Here we investigated the role of SoxE genes in development of the neural crest-derived branchial skeleton in the sea lamprey. Using a morpholino knockdown approach, we show that all three SoxE genes described in lamprey are required for branchial basket development. Our results suggest that SoxE1 and SoxE2 are required for specification of the chondrogenic neural crest. SoxE3 plays a morphogenetic role in patterning of the branchial basket and may be required for the development of mucocartilage, a tissue unique to larval lampreys. While the lamprey branchial basket develops primarily from an elastin-like major extracellular matrix protein that is specific to lampreys, fibrillar collagen is also expressed in developing branchial cartilage and may be regulated by the lamprey SoxE genes. Our data suggest that the regulation of Type II collagen by Sox9 might have been co-opted by the neural crest in development of the branchial skeleton following the divergence of agnathan and gnathostome vertebrates. Finally, our results also have implications for understanding the independent evolution of duplicated SoxE genes among agnathan and gnathostome vertebrates.
Lewis, Charlotte W; Jacob, Lisa S; Lehmann, Christoph U
Orofacial clefts, specifically cleft lip and/or cleft palate (CL/P), are among the most common congenital anomalies. CL/P vary in their location and severity and comprise 3 overarching groups: cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate alone (CP). CL/P may be associated with one of many syndromes that could further complicate a child's needs. Care of patients with CL/P spans prenatal diagnosis into adulthood. The appropriate timing and order of specific cleft-related care are important factors for optimizing outcomes; however, care should be individualized to meet the specific needs of each patient and family. Children with CL/P should receive their specialty cleft-related care from a multidisciplinary cleft or craniofacial team with sufficient patient and surgical volume to promote successful outcomes. The primary care pediatrician at the child's medical home has an essential role in making a timely diagnosis and referral; providing ongoing health care maintenance, anticipatory guidance, and acute care; and functioning as an advocate for the patient and a liaison between the family and the craniofacial/cleft team. This document provides background on CL/P and multidisciplinary team care, information about typical timing and order of cleft-related care, and recommendations for cleft/craniofacial teams and primary care pediatricians in the care of children with CL/P. Copyright © 2017 by the American Academy of Pediatrics.
... throat, hearing, dentistry, speech, oral surgery, nursing, and psychology among others. You can obtain the names of ... of the cleft team, particularly the psychologist and social worker. Interaction with other adults with clefts, through ...
... throat, hearing, dentistry, speech, oral surgery, nursing, and psychology among others. You can obtain the names of ... of the cleft team, particularly the psychologist and social worker. Interaction with other adults with clefts, through ...
Agarwal, Rajiv; Chandra, Ramesh
The correction of alar webbing in unilateral cleft lip nose deformity is challenging because of progressive distortions in the alar web region during the period of growth. Alar webbing is a persistent universal deformity in both the primary and secondary cleft lip noses. The purpose of this article is to study the alar web deformity in adult patients with unilateral cleft lip noses. Twenty-five patients aged 13 years and older presenting with unilateral cleft nasal deformity were included. Preoperative and postoperative measurements of the nose, along with detailed intraoperative recording of the deformed anatomy, were done. Preoperative magnetic resonance imaging was also done in selected cases. Transcolumellar open rhinoplasty was performed in all the cases, and nasal septal straightening with centralization was done. Cleft alar base augmentation was done using bone graft to restore symmetry of the nasal tripod. Both the cleft and noncleft alar cartilages were extensively mobilized from the skin and mucosal sides. The overgrown and caudally slumped cleft-side alar cartilage was resected caudally and was then resuspended in a symmetrical position with the noncleft alar cartilage. A midline-strut septal cartilage extension graft was used to restore the tip aesthetics. The skin overlying the alar web was in-rolled after semilunar cartilage resection, and skin excision was also done to restore symmetry with the opposite vestibule. The remaining secondary cleft nasal and lip deformities were corrected depending upon the specific presenting pathologic abnormality. The cleft alar cartilage was found to be caudally displaced in all the cases. The caudal border of the lateral crus was prolapsing in the cavity of the vestibule on the superomedial aspect and was tenting the skin in the area of the weak triangle, producing the characteristic alar web deformity. In the study group, the maximum width of the cleft alar cartilage at the level of the lateral crus was increased by
Burianova, Iva; Kulihova, Katarina; Vitkova, Veronika; Janota, Jan
Goals of treatment of orofacial cleft are to improve feeding, speech, hearing, and facial appearance. Early surgery brings faster healing, better cosmetic effect, and fewer complications. Breastfeeding rates after early surgery are unknown. Early repair of the cleft lip may influence breastfeeding rates. Research aim: The aim of this study was to evaluate breastfeeding after early repair of the cleft lip in a Baby-Friendly designated hospital. The rate of breastfeeding in newborns with cleft lip was compared to cleft lip and palate. This was a retrospective cohort study. The study group included infants with cleft lip and cleft lip and palate operated on in the first 2 weeks of life. Newborns and their mothers were supported by a team promoting breastfeeding. One hundred four infants (70 boys and 34 girls) were included. Isolated cleft lip was present in 56 (53.8%) infants, and cleft lip and palate in 48 (46.2%). Forty-four (78.6%) of the infants with a cleft lip were breastfed, 3 (5.4%) received human milk via bottle or syringe, and 9 (16.0%) were formula fed. Three (6.2%) of the infants with a cleft lip and palate were breastfed, 31 (64.6%) received human milk via bottle or Haberman feeder, and 14 (29.2%) were formula fed. The rate of breastfeeding in patients following early surgery of the cleft lip was high and comparable to the general population. The rate of breastfeeding in babies with cleft lip and palate after early repair of the cleft lip remained low.
As part of a collaborative project on the epidemiology of craniofacial anomalies, funded by the National Institutes for Dental and Craniofacial Research and channeled through the Human Genetics Programme of the World Health Organization, the International Perinatal Database of Typical Orofacial Clefts (IPDTOC) was established in 2003. IPDTOC is collecting case-by-case information on cleft lip with or without cleft palate and on cleft palate alone from birth defects registries contributing to at least one of three collaborative organizations: European Surveillance Systems of Congenital Anomalies (EUROCAT) in Europe, National Birth Defects Prevention Network (NBDPN) in the United States, and International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) worldwide. Analysis of the collected information is performed centrally at the ICBDSR Centre in Rome, Italy, to maximize the comparability of results. The present paper, the first of a series, reports data on the prevalence of cleft lip with or without cleft palate from 54 registries in 30 countries over at least 1 complete year during the period 2000 to 2005. Thus, the denominator comprises more than 7.5 million births. A total of 7704 cases of cleft lip with or without cleft palate (7141 livebirths, 237 stillbirths, 301 terminations of pregnancy, and 25 with pregnancy outcome unknown) were available. The overall prevalence of cleft lip with or without cleft palate was 9.92 per 10,000. The prevalence of cleft lip was 3.28 per 10,000, and that of cleft lip and palate was 6.64 per 10,000. There were 5918 cases (76.8%) that were isolated, 1224 (15.9%) had malformations in other systems, and 562 (7.3%) occurred as part of recognized syndromes. Cases with greater dysmorphological severity of cleft lip with or without cleft palate were more likely to include malformations of other systems.
Goswami, Jayanta Kumar
A case of midline cleft of the lower lip, mandible, and the neck with complete duplication of the tongue repaired at neonatal period is reported here. Median cleft of the lower lip, mandible, and bifid tongue with ankyloglossia is reported in the literature, but cleft of the neck with complete duplication of the tongue as a part of the Tessier 30 cleft is very rare. We could not find such report in the available English literature. PMID:28082778
Lee, Chung Won; Hwang, Sun Mi; Lee, You Sun; Kim, Min-A; Seo, Kyung
The aim of this study was to investigate the prevalence of orofacial clefts and identify the characteristics of other birth defects associated with orofacial clefts in Korea. This study used data from the Congenital Anomaly Survey conducted by the Korea Institute for Health and Social Affairs. The survey was conducted on birth defects documented during 2005 to 2006 in 2,348 medical institutes in Korea. This study was performed using data from medical insurance claims of the National Health Insurance Corporation. The prevalence of orofacial clefts was defined as the number of cases per 10,000 live births. Among the 883,184 live births, 25,335 infants had birth defects, which included 980 infants with orofacial clefts. The prevalence of total orofacial clefts in the total live births was 11.09 per 10,000, accounting for 3.9% of all birth defects. The most common orofacial cleft was cleft palate only (n=492), followed by cleft lip only (n=245) and cleft lip with cleft palate (n=243), with prevalence rates of 5.57, 2.77, 2.75 per 10,000 live births, respectively. While malformations of the circulatory system; digestive system; eyes, ears, face, and neck; and musculoskeletal system were most frequently encountered among infants with a cleft lip with or without a cleft palate, anomalies of most organ systems were notably observed among infants with cleft palate only. The prevalence of orofacial clefts in Korea was similar or slightly lower than that of other countries. This study informs present status of orofacial clefts and gives baseline data to lay the foundation stone for Korea's registry system of orofacial clefts.
Fujita, K; Akiyama, N; Ishizaki, M; Tanaka, S; Ohsawa, K; Sugiyama, H; Kanoh, K; Toki, F; Asao, T; Kuwano, H
Dermoid cysts are benign cystic teratomas lined by skin and epidermal appendages. We report a dermoid cyst occurring in a 26-year-old female whose chief complaint was irregular vaginal bleeding. Abdominal magnetic resonance image demonstrated a space-occupying lesion in the right lower abdomen. The mass showed hyperintensity on the T2 image and the signal was homogeneous for the interior. During abdominal surgery we made the diagnosis of subserous tumor of the colon and resected the ileocecal portion of the colon. The tumor measured 5.4 x 4.8 x 3.5 cm and was soft and elastic. On cross section, a unilocular cyst filled with atheromatous material was found. Pathological examination revealed a dermoid cyst. In the view of this diagnosis, a simple excision would have been an adequate treatment.
Spini, Roxana G; Bordino, Lucas; Cruz, Daniel; Fitz Maurice, María de Los Ángeles; Martins, Andrea; Michalski, Julian
Maxillary cysts are a diverse group of entities that include benign and malignant odontogenic tumors. Information on the prevalence of this disease is limited. It is more common among males, and usually occurs in the second and third decade of life. The proportion of 6 to 7 year old patients with dentigerous cysts is only 9.1%. Dentigerous cysts encompass the crown of a permanent and unerupted impacted teeth. They are usually slow growing asymptomatic lesions that are not discovered until they affect surrounding organs. The aim of this study is to present an unusual case of dentigerous cyst and to inform the pediatrician about the management of a unilateral maxillary tumor in a healthy child, underlining the importance of a multidisciplinary approach of this disease.
Bessell, Alyson; Hooper, Lee; Shaw, William C; Reilly, Sheena; Reid, Julie; Glenny, Anne-Marie
Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. Five RCTs with a total of 292 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (two studies). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require
Breves, Jason P; Seale, Andre P; Moorman, Benjamin P; Lerner, Darren T; Moriyama, Shunsuke; Hopkins, Kevin D; Grau, E Gordon
This study investigated endocrine control of branchial ionoregulatory function in Nile tilapia (Oreochromis niloticus) by prolactin (Prl188 and Prl177), growth hormone (Gh) and cortisol. Branchial expression of Na(+)/Cl(-) cotransporter (ncc) and Na(+)/K(+)/2Cl(-) cotransporter (nkcc) genes were employed as specific markers for freshwater- and seawater-type ionocytes, respectively. We further investigated whether Prl, Gh and cortisol direct expression of two Na(+), K(+)-ATPase (nka)-α1 subunit genes, denoted nka-α1a and nka-α1b. Tilapia transferred to fresh water following hypophysectomy failed to adequately activate gill ncc expression; ncc expression was subsequently restored by Prl replacement. Prl188 and Prl177 stimulated ncc expression in cultured gill filaments in a concentration-related manner, suggesting that ncc is regulated by Prl in a gill-autonomous fashion. Tilapia transferred to brackish water (23 ‰) following hypophysectomy exhibited a reduced capacity to up-regulate nka-α1b expression. However, Gh and cortisol failed to affect nka-α1b expression in vivo. Similarly, we found no clear effects of Gh or cortisol on nkcc expression both in vivo and in vitro. When considered with patterns previously described in euryhaline Mozambique tilapia (O. mossambicus), the current study suggests that ncc is a conserved target of Prl in tilapiine cichlids. In addition, we revealed contrasting dependencies upon the pituitary to direct nka-α1b expression in hyperosmotic environments between Nile and Mozambique tilapia.
Azevedo-Linhares, Maristela; Freire, Carolina A
In this study, we investigated the use of branchial carbonic anhydrase activity in a sessile filter feeding species, the oyster Crassostrea rhizophorae, as a biomarker. The oysters were collected in three human impacted Brazilian estuaries, following a crescent latitudinal gradient: in Pernambuco state (Itamaracá), in Espírito Santo state (Piraquê), and in Paraná state (Paranaguá), in August/2003 (Winter in the southern hemisphere) and February/2004 (Summer). Three sites were chosen in each estuary for oyster sampling: Reference (R), Contaminated 1 (C1, close to industrial/harbor contamination), and Contaminated 2 (C2, near to sewage discharges). Comparing to values in oysters sampled in reference sites, there was apparent inhibition in carbonic anhydrase activity (CAA) in gills of oysters from C1 of Itamaracá and from C2 of Piraquê, both cases in Summer. On the other hand, increased CAA was noted in C2 oysters of Itamaracá in winter, and of Paranaguá, in both seasons. Branchial CAA in C. rhizophorae was thus very responsive to coastal contamination. Data are consistent with its usefulness as a supporting biomarker for inexpensive and rapid analysis in the assessment of estuaries using a sessile osmoconformer species, but preferably allied to other biomarkers and with knowledge on the suite of contaminants present. Copyright © 2015. Published by Elsevier Inc.
Fillies, Thomas; Homann, Christoph; Meyer, Ulrich; Reich, Alexander; Joos, Ulrich; Werkmeister, Richard
Background Cleft surgery in infants includes special risks due to the kind of the malformation. These risks can be attributed in part to the age and the weight of the patient. Whereas a lot of studies investigated the long-term facial outcome of cleft surgery depending on the age at operation, less is known about the complications arising during a cleft surgery in early infancy. Methods We investigated the incidence and severity of perioperative complications in 174 infants undergoing primary cleft surgery. The severity and the complications were recorded during the intraoperative and the early postoperative period according to the classification by Cohen. Results Our study revealed that minor complications occurred in 50 patients. Severe complications were observed during 13 operations. There was no fatal complication in the perioperative period. The risk of complications was found to be directly correlated to the body weight at the time of the surgery. Most of the problems appeared intraoperatively, but they were also followed by complications immediately after the extubation. Conclusion In conclusion, cleft surgery in infancy is accompanied by frequent and sometimes severe perioperative complications that may be attributed to this special surgical field. PMID:17280602
Veyssière, Alexis; Streit, Libor; Traoré, Hamady; Bénateau, Hervé
A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.
... of oral clefts. Q8. Does FDA have post marketing adverse event reports of oral clefts with topiramate? ... based on adverse reaction data from investigational or marketing experience or studies in humans, BUT the potential ...
Chen, Zhen-Qi; Wu, Jun; Chen, Rong-Jing
The objective of the study was to examine the sagittal maxillary growth pattern during the mixed and permanent dentition in unilateral cleft lip and palate (UCLP) patients with unrepaired cleft palate. A total of 30 nonsyndromic UCLP patients with unrepaired cleft palate were included, 15 of whom were in mixed dentition and 15 in permanent dentition.Cephalograms were analyzed and compared in the patients with UCLP who have operatively undergone repair with both the lip and palate as well as normal subjects. The UCLP patients with unrepaired cleft palate in mixed dentition showed decreased anterior-posterior length of the maxilla. The UCLP patients with unrepaired cleft palate in permanent dentition demonstrated an almost normal maxillary growth. The operated-on patients both in mixed and permanent dentitions showed maxillary retrusion as well as decreased maxillary length. There appears that there may be the potential normal maxillary growth in UCLP patients, and early surgical repair of the cleft palate may affect sagittal maxillary growth pattern in patients with cleft.
Huang, Andrew H; Patel, Kamlesh B; Maschhoff, Clayton W; Huebener, Donald V; Skolnick, Gary B; Naidoo, Sybill D; Woo, Albert S
To determine a correlation between the width of the cleft palate measured at the time of lip adhesion, definitive lip repair, and palatoplasty and the subsequent occlusal classification of patients born with unilateral cleft lip and palate. Retrospective, observational study. Referral, urban, children's hospital Participants : Dental models and records of 270 patients were analyzed. None. Angle occlusion classification. The mean age at which occlusal classification was determined was 11 ± 0.3 years. Of the children studies, 84 were diagnosed with Class I or II occlusion, 67 were diagnosed with Class III occlusion, and 119 were lost to follow up or transferred care. Mean cleft widths were significantly larger in subjects with Class III occlusion for all measures at time of lip adhesion and definitive lip repair (P < .02). At time of palatoplasty, cleft widths were significantly greater at the alveolus (P = .025) but not at the midportion of the hard palate (P = .35) or posterior hard palate (P = .10). Cleft widths from the lip through to the posterior hard palate are generally greater in children who are diagnosed with Class III occlusion later in life. Notably, the alveolar cleft width is significantly greater at each time point for patients who went on to develop Class III occlusion. There were no significant differences in cleft widths between patients diagnosed later with Class I and Class II occlusions.
Marazita, Mary L; Mooney, Mark P
Many mechanisms underlying normal and abnormal craniofacial embryogenesis are well understood. The genetic factors that provoke abnormal development and result in orofacial clefts are not clear, but much progress has occurred in our understanding. Genes or chromosomal rearrangements on many chromosomes can lead to syndromes that include orofacial clefts. This diversity in the mechanisms that can lead to syndromic clefts highlights the fact that the processes leading to the development of the oral cavity and face are complex and sensitive to disturbances at multiple timepoints or within multiple genetic domains. As for nonsyndromic clefting, large-scale family studies are consistent with one or a few loci exerting major effects on phenotypic expression, although no single gene has been identified as a "necessary" locus for development of nonsyndromic clefts. Rather, the emerging consensus is that the genetic etiology of nonsyndromic clefting is complex, with several loci showing significant results in at least some studies. Some of these loci may be genes for susceptibility to environmental factors, some may be modifying loci, and some may be "necessary" loci. Mutations in genes that are now known to control early development are logical candidate genes for future studies of nonsyndromic orofacial clefting. Continued genetic analyses and developmental studies are crucial for eventual understanding of the complex etiology of these common congenital anomalies.
Casal, C; Domínguez, C; Fernández, A; Sarget, R; Martínez-Celdrán, E; Sentís-Vilalta, J; Gay-Escoda, C
Twenty-two consecutive children with repaired cleft lip and/or palate [isolated cleft lip (CL) 6, isolated cleft palate (CP) 7, unilateral cleft lip and palate (UCLP) 7, and bilateral cleft lip and palate 2] with a mean age of 27 months underwent spectrographic measures of tape-recorded speech (DSP Sona-Graph digital unit). Controls were 22 age- and sex-matched noncleft children. Data analyzed included (1) the Spanish vocalic variables [a, i, u, e, o]: first formant, second formant, duration, and context; (2) obstruent variables [p, t, k]: burst, voice onset time, and duration, and (3) nasal variables [m]: first formant, second formant, and duration. Statistically significant differences were observed between the CL group and the control group in the first formant of [e] and in the increase of the frequency of the [t] burst. Comparison between UCLP and controls showed differences in the second formant of [a], in the first formant of [o], and in the second formant of [o]. These results suggest a small but significant influence of either the cleft lip or its repair on lip rounding for [o] and [u]. In addition, tongue position differences were most likely responsible for the differences seen with [a] and [e]. Spectrographic differences in the current patients did not contribute to meaningful differences in speech sound development. Individualized care (orthodontics, surgery, speech therapy) in children with cleft lip and/or palate attended at specialized craniofacial units contributes to normalization of speech development.
Stal, S; Klebuc, M; Taylor, T D; Spira, M; Edwards, M
Developing standardized outcomes and algorithms of treatment is a constantly evolving task. This article examines four variables in this process: cleft type, operative technique, surgical experience, and timing. Input from international cleft lip and palate programs regarding techniques and treatment modalities provide a dynamic tool for assessment and the development of guidelines in the treatment of the cleft lip and palate patient.
McClellan, Kathy; Howard, Kevin; Mayhew, Elizabeth; Niederkorn, Jerry; Alizadeh, Hassan
Acanthamoeba cysts are not eliminated from the corneas of human subjects or experimentally infected animals. The persistence of Acanthamoeba cysts in the cornea indicates that either the cysts escape immunological elimination or are not recognized by the host's immunological elements. The aim of this study was to determine the immunogenicity and antigenicity of the Acanthamoeba cyst. Mice were immunized intraperitoneally and serum anti-Acanthamoeba IgG was measured by ELISA. Lymphoproliferative assay and delayed type hypersensitivity (DTH) responses to Acanthamoeba castellanii cyst and trophozoite antigens were used to determine the cell mediated immune responses against Acanthamoeba cysts. A. castellanii cysts were both immunogenic and antigenic, producing anti-Acanthamoeba serum IgG, T lymphocyte proliferation, and delayed type hypersensitivity responses. These results indicate that Acanthamoeba cysts are recognized by the immune system. The persistence of the organism in the human cornea means that these adaptive immune responses fail to kill Acanthamoeba cysts.
Thatte, Shreya; Jain, Jagriti; Kinger, Mallika; Palod, Sapan; Wadhva, Jatin; Vishnoi, Avijit
Purpose This is a clinco-histopathological study of different varieties of conjunctival cysts where modification of surgical technique was done as per requirement for intact removal of cysts to minimise recurrence rate. Materials and methods Retrospective study of 40 cases of conjunctival cysts. A thorough ocular examination and basic haematological work up was done for all patients. B-scan USG and MRI was done wherever required to see the posterior extent. All patients underwent surgical excision of cyst followed by histo-pathological examination. Results The various types of conjunctival cysts found in our study were primary inclusion cyst 12 (30%), secondary inclusion cyst 6 (15%), pterygium with cysts 15 (37.5%), parasitic cyst 4 (10%), lymphatic cyst 2 (5%), and orbital cyst with rudimentary eye 1 (2.5%). The common symptoms noted were progressive increase in size of cyst (39.45%), cosmetic disfigurement (26.23%), foreign body sensations (27.86%), proptosis (1.6%), ocular motility restrictions (3.2%) and decreased visual acuity (1.6%). The patients were followed till one year after surgical excision for any recurrence and complications and no recurrence was seen. Conclusion Careful and intact removal of conjunctival cyst is important to prevent recurrence. Minor modifications in surgical technique according to the size, site and nature of cyst help in intact removal and prevent recurrence. PMID:25892928
Maternal ingestion of Nicotiana glauca from gestation days 32 through 41 results in a high incidence of cleft palate in Spanish goats. This caprine cleft palate model was used to evaluate the temporal sequence of palatal shelf fusion throughout the period of cleft induction with the poisonous plant...
Sarmast, Arif Hussain; Showkat, Hakim Irfan; Parray, Fazl Q; Lone, Rubina
Primary splenic cyst is a rare entity and majority of the cases are classified as epithelial cysts. They are uncommon, comprising only about 10% of benign non-parasitic cysts. Most of the cysts are asymptomatic, and they are incidental findings during abdominal ultrasonography. We report a case of 20 years old male who presented with 1 year history of mild abdominal pain and left upper quadrant fullness. Ultrasound and computed tomography (CT) both were suggestive of splenic cyst. Serological tests were negative for parasitic infection. Splenectomy was done. Histopathological findings are consistent with splenic epithelial cyst.
Moralioğlu, Serdar; Bosnalı, Oktav; Celayir, Ayşenur Cerrah; Şahin, Ceyhan
Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage. PMID:24049387
TETTAMANTI, L.; AVANTAGGIATO, A.; NARDONE, M.; SILVESTRE-RANGIL, J.; TAGLIABUE, A.
SUMMARY Cleft palate only (CPO) is one of the most common congenital malformations worldwide. The etiopathogenesis of CPO is not completely understood. Environmental factors, such as smoking, alcohol consumption, intake of drugs during pregnancy, advanced paternal age, have been demonstrated to be a risk of CPO, but conflicting results have also been published. Insufficient intake of folic acid during the pregnancy has been suggested to increase the risk for CPO. The demonstrated risk for siblings and the higher risk for monozygotic twins suggest a genetic etiopathogenesis for CPO. In some cases of CPO a prevalent mode of inheritance has been reported, but oligogenic models with reduced penetrance, and the risk related to environmental factors have also been proved. One of the first manifestations associated with CPO is difficulty with feeding. Aerophagia is a problem in these infants with CPO and requires more frequent burping and slower feeding. The inability to generate intraoral breath pressure due to nasal air emission in CPO children frequently manifests as articulation difficulties, particularly consonant weakness, and unintelligible speech. Hearing disorders are prevalent among individuals with CPO, as a result of chronic otitis media with effusion due to eustachian tube dysfunction. A multidisciplinary team is essential to manage the many aspects of CPO. In treating CPO, the reconstructive surgeon works in cooperation with otolaryngologists, dentists and orthodontists, speech pathologists, audiologists, geneticists, psychiatrists, maxillofacial surgeons, social workers, and prosthodontists. CPO can be considered a genetically complex disease, but new knowledge and new therapeutic approaches have greatly improved the quality of life of these children. Prenatal diagnosis is an important step in the treatment of this disease. PMID:28757935
Tettamanti, L; Avantaggiato, A; Nardone, M; Silvestre-Rangil, J; Tagliabue, A
Cleft palate only (CPO) is one of the most common congenital malformations worldwide. The etiopathogenesis of CPO is not completely understood. Environmental factors, such as smoking, alcohol consumption, intake of drugs during pregnancy, advanced paternal age, have been demonstrated to be a risk of CPO, but conflicting results have also been published. Insufficient intake of folic acid during the pregnancy has been suggested to increase the risk for CPO. The demonstrated risk for siblings and the higher risk for monozygotic twins suggest a genetic etiopathogenesis for CPO. In some cases of CPO a prevalent mode of inheritance has been reported, but oligogenic models with reduced penetrance, and the risk related to environmental factors have also been proved. One of the first manifestations associated with CPO is difficulty with feeding. Aerophagia is a problem in these infants with CPO and requires more frequent burping and slower feeding. The inability to generate intraoral breath pressure due to nasal air emission in CPO children frequently manifests as articulation difficulties, particularly consonant weakness, and unintelligible speech. Hearing disorders are prevalent among individuals with CPO, as a result of chronic otitis media with effusion due to eustachian tube dysfunction. A multidisciplinary team is essential to manage the many aspects of CPO. In treating CPO, the reconstructive surgeon works in cooperation with otolaryngologists, dentists and orthodontists, speech pathologists, audiologists, geneticists, psychiatrists, maxillofacial surgeons, social workers, and prosthodontists. CPO can be considered a genetically complex disease, but new knowledge and new therapeutic approaches have greatly improved the quality of life of these children. Prenatal diagnosis is an important step in the treatment of this disease.
Anderson, Peter J; Snell, Broughton; Moore, Mark H
Muencke syndrome results from mutations in the FGFR3 gene, and although it is well recognized that the clinical presentation is variable, the important key finding includes coronal synostosis. We present a family where a mother with proven FGFR3 Pro250Arg mutation gave birth to identical twins both of whom had craniosynostosis but had coexisting bilateral cleft lip and palate. We believe that this is the first description of clefting occurring in conjunction with Muencke syndrome and so further extends the range of phenotypic variation that can occur in this syndrome.
Kummer, Ann W
Children with cleft palate are at risk for speech problems, particularly those caused by velopharyngeal insufficiency. There may be an additional risk of speech problems caused by malocclusion. This article describes the speech evaluation for children with cleft palate and how the results of the evaluation are used to make treatment decisions. Instrumental procedures that provide objective data regarding the function of the velopharyngeal valve, and the 2 most common methods of velopharyngeal imaging, are also described. Because many readers are not familiar with phonetic symbols for speech phonemes, Standard English letters are used for clarity.
Rowicka, Grażyna; Weker, Halina
Treatment of children with orofacial clefts is a multi-stage process, usually extending over many years and requiring intervention of numerous specialists. Most of the problems in such children before the tissue reconstruction surgery are related to feeding and airway protection during swallowing. Feeding of children with orofacial clefts is the more difficult the more severe the defect is. Such children are at an increased risk of body weight deficit and malnutrition. The aim of the study is to present the nutritional standard for children with orofacial clefts. Feeding principles for children with orofacial clefts: If the clinical state of the child and the emotional state of the mother allow, children with orofacial clefts should be breastfed or bottle-fed with breast milk. If feeding with breast milk is not possible, children should receive appropriate formulas for infants. Their diet can usually be expanded at the same time as in healthy infants and should comply with the nutritional model or standard for children aged 6-12 months. Various feeding techniques are used in children with orofacial clefts, depending not only on the type of the defect, but also the experience of the institution taking care of the child. Such children may require a diet with higher calories due to their increased energy expenditure related to eating. In the case of body weight deficit and/or malnutrition resulting from inadequate diet, a change of the feeding technique should be considered, and, subsequently, a diet modification. The modification may mean an extra formula feeding (in children fed with breast milk) or earlier introduction of supplementary foods. Sometimes a different feeding method than oral feeding must be used, e.g. through a naso-gastric tube or, in extreme cases, a feeding stoma. It is of utmost importance that infants with the said defects gain the optimal body weight before the planned operation, since malnutrition may be a significant reason for delaying the
Miyake, Tomoko; Kojima, Shota; Sugiyama, Tetsuya; Ueki, Mari; Sugasawa, Jun; Oku, Hidehiro; Tajiri, Kensuke; Shigemura, Yuka; Ueda, Koichi; Harada, Atsuko; Yamasaki, Mami; Yamanaka, Takumi; Utsunomiya, Hidetsuna; Ikeda, Tsunehiko
Introduction The incidence of facial cleft is rare and ranges between 1.43 and 4.85 per 100,000 births. To date, there have been few reports of detailed ophthalmologic examinations performed in cases of facial cleft. Here, we report a case of optic-nerve hypoplasia and anterior segment abnormality associated with facial cleft. Case report A 9-day-old female infant was delivered by cesarian section at 34 weeks of gestational age (the second baby of twins) and weighed 2,276 g upon presentation. She had a facial cleft and ectrodactyly at birth. Right eye-dominant blepharophimosis was obvious. Examination of the right eye revealed inferior corneal opacity with vascularization, downward corectopia, and optic-nerve hypoplasia. The corneal diameter was 8 mm in both eyes, and tonometry by use of a Tono-Pen® XL (Reichert Technologies, Depew, NY, USA) handheld applanation tonometer revealed that her intraocular pressure was 11–22 mmHg (Oculus Dexter) and 8 mmHg (Oculus Sinister). B-mode echo revealed no differences in axial length between her right and left eyes. When she was 15–16 months old, we attempted to examine her eyes before she underwent plastic surgery under general anesthesia. She had a small optic disc in both eyes and the right-eye disc was tilted. After undergoing canthotomy, gonioscopy and ultrasound biomicroscopy revealed that almost all directions were open except for the peripheral anterior synechia. Since magnetic resonance imaging revealed ventriculomegaly associated with an interhemispheric cyst at birth, a ventriculoperitoneal shunt was inserted at 12 days of age. At 25 months of age, her condition suddenly deteriorated due to occlusion of the ventricular shunt catheter, and she died 5 days later. In this patient, amniotic band syndrome was presumed to be the primary cause due to the clinical findings. Conclusion We experienced a case of optic-nerve hypoplasia and anterior segment abnormality that occurred with facial cleft. The cause of these
Fernández Ibieta, M; Rojas Ticona, J; Martinez Castaño, I; Reyes Rios, P; Villamil, V; Giron Vallejo, O; Mendez Aguirre, N; Sanchez Morote, J; Aranda Garcia, M J; Guirao Piñera, M J; Zambudio Carmona, G; Ruiz Pruneda, R; Ruiz Jiménez, J I
Mesenteric cysts (MC) are benign cystic tumors that grow within mesentery or omentum tissue. We have reviewed the cases of MC reported and operated on in our centre. Retrospective review of clinical records of MC cases during the period 2002-2012 RESULTS: A total of 7 patients were found. Mean age was 5.3 years (range 3-11). Abdominal ultrasound was the diagnostic tool in all cases, except for one, which was diagnosed during laparotomy. All presented abdominal pain, 5 (71.4%) vomiting, 4 (57%) gross abdominal distension, 3 (42.8%) fever, and none presented complete abdominal obstruction, although 2 patients (28.6%) had slight sub-occlusion symptoms. All MC were pedicled or sesil, except for our last case, which extended into the retroperitoneum. All specimens were reported as Limphatic Malformation. None recurred. MC in children are mostly Lymphatic Malformations of mesentery or omentum origin, and clinical presentation varies from chronic abdominal pain to sudden-onset peritonitis or volvulus. About 50-60% require intestinal resection and anastomosis. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
Eib, D.W.; Hossner, K.L.
Injections of cortisol, actinomycin D, or combined administration of the hormone and the antiobiotic did not effect rainbow trout (Salmo gairdneri) branchial Na+K+-ATPase activity. Numbers of chloride cells also did not change following cortisol and actinomycin D treatment. These results are discussed in light of a similar report concerning Atlantic salmon (Salmo salar).
Yang, Wen-Kai; Kang, Chao-Kai; Chen, Tzu-Ying; Chang, Wen-Been; Lee, Tsung-Han
In the branchial mitochondrion-rich (MR) cells of euryhaline teleosts, the Na(+)/K(+)/2Cl(-) cotransporter (NKCC) is an important membrane protein that maintains the internal Cl(-) concentration, and the branchial Na(+)/K(+)-ATPase (NKA) is crucial for providing the driving force for many other ion-transporting systems. Hence this study used the sailfin molly (Poecilia latipinna), an introduced aquarium fish in Taiwan, to reveal that the potential roles of NKCC and NKA in sailfin molly were correlated to fish survival rates upon salinity challenge. Higher levels of branchial NKCC were found in seawater (SW)-acclimated sailfin molly compared to freshwater (FW)-acclimated individuals. Transfer of the sailfin molly from SW to FW revealed that the expression of the NKCC and NKA proteins in the gills was retained over 7 days in order to maintain hypoosmoregulatory endurance. Meanwhile, their survival rates after transfer to SW varied with the duration of FW-exposure and decreased significantly when the SW-acclimated individuals were acclimated to FW for 21 days. Double immunofluorescence staining showed that in SW-acclimated sailfin molly, NKCC signals were expressed on the basolateral membrane of MR cells, whereas in FW-acclimated molly, they were expressed on the apical membrane. This study illustrated the correlation between the gradual reductions in expression of branchial NKCC and NKA (i.e., the hypoosmoregulatory endurance) and decreasing survival rates after hyperosmotic challenge in sailfin molly.
Ganapathy, Arthi; T, Sadeesh; Swer, Mary Hydrina; Rao, Sudha
A 21-week-old still born female fetus with occipital encepholocele, cleft lip and cleft palate was received from the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry and was studied in detail. It was born to Primigravida, of a second degree consanguineous marriage, with unremarkable family history. The biometric measurements were noted which corresponded to the age of the fetus. Further the fetus was embalmed and dissected. On examination an encephalocele of 2.7×1.5 cm was seen in the occipital region with a midline defect in the occipital bone and herniated brain tissue. Other anomalies observed were right unilateral cleft lip, right cleft palate, and bilateral syndactyly of the lower limbs and associated Congenital Talipus Equino Varus of the right foot. Other internal organs were developed appropriate for the age of the fetus.
T, Sadeesh; Swer, Mary Hydrina; Rao, Sudha
A 21-week-old still born female fetus with occipital encepholocele, cleft lip and cleft palate was received from the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry and was studied in detail. It was born to Primigravida, of a second degree consanguineous marriage, with unremarkable family history. The biometric measurements were noted which corresponded to the age of the fetus. Further the fetus was embalmed and dissected. On examination an encephalocele of 2.7×1.5 cm was seen in the occipital region with a midline defect in the occipital bone and herniated brain tissue. Other anomalies observed were right unilateral cleft lip, right cleft palate, and bilateral syndactyly of the lower limbs and associated Congenital Talipus Equino Varus of the right foot. Other internal organs were developed appropriate for the age of the fetus. PMID:25653933
Wright, Patricia A; Wood, Chris M; Hiroi, Junya; Wilson, Jonathan M
Freshwater fishes generally increase ammonia excretion in acidic waters. The new model of ammonia transport in freshwater fish involves an association between the Rhesus (Rh) protein Rhcg-b, the Na(+)/H(+) exchanger (NHE), and a suite of other membrane transporters. We tested the hypothesis that Rhcg-b and NHE3 together play a critical role in branchial ammonia excretion in common carp (Cyprinus carpio) chronically exposed to a low-pH environment. Carp were exposed to three sequential environmental treatments-control pH 7.6 water (24 h), pH 4.0 water (72 h), and recovery pH 7.6 water (24 h)-or in a separate series were simply exposed to either control (72 h) or pH 4.0 (72 h) water. Branchial ammonia excretion was increased by ∼2.5-fold in the acid compared with the control period, despite the absence of an increase in the plasma-to-water partial pressure NH3 gradient. Alanine aminotransferase activity was higher in the gills of fish exposed to pH 4 versus control water, suggesting that ammonia may be generated in gill tissue. Gill Rhcg-b and NHE3b messenger RNA levels were significantly elevated in acid-treated relative to control fish, but at the protein level Rhcg-b decreased (30%) and NHE3b increased (2-fold) in response to water of pH 4.0. Using immunofluorescence microscopy, NHE3b and Rhcg-b were found to be colocalized to ionocytes along the interlamellar space of the filament of control fish. After 72 h of acid exposure, Rhcg-b staining almost disappeared from this region, and NHE3b was more prominent along the lamellae. We propose that ammoniagenesis within the gill tissue itself is responsible for the higher rates of branchial ammonia excretion during chronic metabolic acidosis. Unexpectedly, gill Rhcg-b does not appear to be important in gill ammonia transport in low-pH water, but the strong induction of NHE3b suggests that some NH4(+) may be eliminated directly in exchange for Na(+). These findings contrast with previous studies in larval zebrafish
Little, Julian; Cardy, Amanda; Munger, Ronald G.
OBJECTIVE: To examine the association between maternal smoking and non-syndromic orofacial clefts in infants. METHODS: A meta-analysis of the association between maternal smoking during pregnancy was carried out using data from 24 case-control and cohort studies. FINDINGS: Consistent, moderate and statistically significant associations were found between maternal smoking and cleft lip, with or without cleft palate (relative risk 1.34, 95% confidence interval 1.25-1.44) and between maternal smoking and cleft palate (relative risk 1.22, 95% confidence interval 1.10-1.35). There was evidence of a modest dose-response effect for cleft lip with or without cleft palate. CONCLUSION: The evidence of an association between maternal tobacco smoking and orofacial clefts is strong enough to justify its use in anti-smoking campaigns. PMID:15112010
Moreno, Nuno; Almeida, Jorge; Amorim, Mário Jorge
In this report, we present the case of an adult male with severe mitral regurgitation due to an atrioventricular septal defect. Anatomical assessment by two- and three-dimensional transesophageal echocardiography was essential for detailed morphological characterization and surgical planning. The different features of a 'cleft' in an atrioventricular septal defect compared to an anterior leaflet cleft in an otherwise normal mitral valve are here discussed. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Başgül, A; Kavak, Z N; Gökaslan, H; Küllü, S
BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of Echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts. PMID:12530482
Skuladottir, Hildur; Sivertsen, Ase; Assmus, Jorg; Remme, Asa Rommetveit; Dahlen, Marianne; Vindenes, Hallvard
Objective : Children with cleft lip and palate or cleft palate only have a high incidence of conductive hearing loss from otitis media with effusion. Studies demonstrating longitudinal results are lacking. This study was undertaken to investigate long-term longitudinal hearing outcomes of children with cleft lip and/or cleft palate and cleft palate only. Design : Retrospective chart review. Setting : Clinical charts of patients born with cleft lip and palate or cleft palate only in 1985 to 1994 who were referred to the cleft team in Bergen, Norway. Study findings include 15 years of follow-up. Participants : The study population consisted of 317 children of whom 159 had nonsyndromic cleft lip and palate and 158 had nonsyndromic cleft palate. Main Outcome Measures : Pure tone average calculated from pure tone audiometry at ages 4, 6, and 15 years. Results : The median pure tone average significantly improved with increasing age. For the cleft lip and palate group, the median pure tone average at ages 4, 6, and 15 years was 16 dB hearing level (HL), 13 dB HL, and 9 dB HL, respectively (P ≤ .001). In the cleft palate group the median pure tone average at ages 4, 6, and 15 years was 15 dB HL, 12 dB HL, and 9 dB HL, respectively (P ≤ .001). There was no significant difference in the hearing levels between the two groups. Patients who had surgical closure of the palate at age 18 months had a significantly better pure tone average outcome at age 15 compared with patients who had surgery at 12 months. Conclusions : Hearing improves significantly from childhood to adolescence in patients with cleft lip and palate and cleft palate only.
Ishii, Kazuhiko; Yuzurihara, Masahito; Asamoto, Shunji; Doi, Hiroshi; Kubota, Motoo
Perineural cysts have become a common incidental finding during lumbosacral magnetic resonance (MR) imaging. Only some of the symptomatic cysts warrant treatment. The authors describe the successful operative treatment of a patient with, to the best of their knowledge, the largest perineural cyst reported to date. A 29-year-old woman had been suffering from long-standing constipation and low-back pain. During an obstetric investigation for infertility, the clinician discovered a huge presacral cystic mass. Computed tomography myelography showed the lesion to be a huge Tarlov cyst arising from the left S-3 nerve root and compressing the ipsilateral S-2 nerve. The cyst was successfully treated by ligation of the cyst neck together with sectioning of the S-3 nerve root. Postoperative improvement in her symptoms and MR imaging findings were noted. Identification of the nerve root involved by the cyst wall, operative indication, operative procedure, and treatment of multiple cysts are important preoperative considerations.
Kumar, Piyush; Das, Anupam; Savant, Sushil S; Barkat, Rizwana
Median raphe cysts are rare congenital lesions ofthe male genitalia that occur as a result of alteredembryologic development. We report two such casesof median raphe cysts in the pediatric age group. Inaddition, we review the literature.
Goh, Rachel L Z; Hardy, Thomas G; Williams, Richard A; McNab, Alan A
To describe post-traumatic and congenital respiratory epithelial cysts in the orbit, which are rare lesions with only 5 and 13 published cases, respectively. We reviewed all cases of respiratory epithelial cysts diagnosed at three institutions (two tertiary referral hospitals, one private clinic) between 1995 and 2015. We describe 10 cases of post-traumatic respiratory epithelial cyst (age range 23 - 82), presenting a mean of 17.4 years after their original trauma; and 3 congenital cases (age range 17-34). All but one case underwent surgical excision of the cyst and its lining, along with any surgical implant within the cyst. Two were recurrent after incomplete excision. Three presented with acute infection within the cyst. Respiratory epithelial orbital cysts are probably commoner than the paucity of published reports would suggest. Post-traumatic cysts often present many years after trauma, and may become secondarily infected. Complete surgical removal is recommended to prevent future recurrence.
Background. The opportunity to provide free surgical care for orofacial clefts has opened a new vista and is enhanced by well-informed communities who are aware of the free surgical services available to them. It is the responsibility of cleft care providers to adequately inform these communities via a combination of community mobilization and awareness creation. Methods. This was a nationwide, cross-sectional descriptive study of all orofacial cleft service providers in Nigeria using a structured, self-administered questionnaire. Results. A total of 4648 clefts have been repaired, 50.8% by the ten government-owned and 49.2% by the five nongovernment-owned organizations included in the study. The nongovernment-owned institutions seemed to be more aggressive about community mobilization and awareness creation than government-owned ones, and this was reflected in their patient turnout. Most of the organizations studied would prefer a separate, independent body to handle their awareness campaign. Conclusion. Community mobilization requires skill and dedication and may require formal training or dedicated budgets by government-owned and nongovernment-owned institutions alike. Organizations involved in cleft care provision must take community mobilization and awareness seriously if the largely unmet needs of orofacial cleft patients in Nigeria are to be tackled. PMID:27350971
Breves, Jason P.; Fujimoto, Chelsea K.; Phipps-Costin, Silas K.; Einarsdottir, Ingibjörg E.; Björnsson, Björn Thrandur; McCormick, Stephen
BackgroundIn preparation for migration from freshwater to marine habitats, Atlantic salmon (Salmo salar L.) undergo smoltification, a transformation that includes the acquisition of hyposmoregulatory capacity. The growth hormone (Gh)/insulin-like growth-factor (Igf) axis promotes the development of branchial ionoregulatory functions that underlie ion secretion. Igfs interact with a suite of Igf binding proteins (Igfbps) that modulate hormone activity. In Atlantic salmon smolts, igfbp4,−5a,−5b1,−5b2,−6b1 and−6b2 transcripts are highly expressed in gill. We measured mRNA levels of branchial and hepatic igfbps during smoltification (March, April, and May), desmoltification (July) and following seawater (SW) exposure in March and May. We also characterized parallel changes in a broad suite of osmoregulatory (branchial Na+/K+-ATPase (Nka) activity, Na+ /K + /2Cl − cotransporter 1 (nkcc1) and cystic fibrosis transmembrane regulator 1 (cftr1) transcription) and endocrine (plasma Gh and Igf1) parameters.ResultsIndicative of smoltification, we observed increased branchial Nka activity, nkcc1 and cftr1 transcription in May. Branchial igfbp6b1 and -6b2 expression increased coincidentally with smoltification. Following a SW challenge in March, igfbp6b1 showed increased expression while igfbp6b2 exhibited diminished expression. igfbp5a,−5b1 and−5b2 mRNA levels did not change during smolting, but each had lower levels following a SW exposure in March.ConclusionsSalmonids express an especially large suite of igfbps. Our data suggest that dynamic expression of particular igfbps accompanies smoltification and SW challenges; thus, transcriptional control of igfbps may provide a mechanism for the local modulation of Igf activity in salmon gill.
Vanessa Martin travelled with a surgical team to Romania over a period of 12 years to support nurses and improve practice in the treatment of cleft lip and palate. She recounts her experiences and the changes that took place during that time.
This literature review examines parental reactions following the birth of a cleft lip/palate child, focusing primarily on the mother's reactions. The research studies cited have explored such influences on maternal reactions as her feelings of lack of control over external forces and her feelings of guilt that the deformity was her fault. Delays…
Rychlik, Dariusz; Wójcicki, Piotr; Koźlik, Maciej
Cleft of lip, alveolar process and palate is the most common congenital defect affecting the face. It occurs at the time of early embryogenesis as a result of disturbed differentiation of the primordial cell layer and is associated with genetic and environmental factors. The most severe type of the defect is complete cleft of the lip, alveolar process and palate, unilateral or bilateral, which is accompanied by impaired breathing, sucking, swallowing, chewing, hearing and speaking. The treatment consists in the surgical reconnection (reconstruction) of the cleft anatomical structures and their formation to gain proper appearance, occlusal conditions and speech. The part of the surgical treatment is reconstruction of alveolar bone by means of autogenic spongy bone grafting (osteoplasty). The surgery performed at the stage of mixed dentition following an orthodontic treatment is a recognized standard management modality. Its effects provide stabilization of the dental arches fixed in the orthodontic treatment, possibility of growth of permanent teeth adjoining the cleft as well as separation of the nasal and oral cavities. The grafted bone becomes a platform for the collapsed base of the ala nasi and facilitates restoration of teeth loss. In the graft healing process the volume of the regenerated bone tissue is lower than the graft volume. Methods to augment the healed bone volume are being searched for, as this factor decides substantially on successful outcome of the surgery.
Vanpoelvoorde, Leah; Shaughnessy, Michael F.
This paper reviews parents' emotional reactions following the birth of a cleft lip/palate child. It examines when parents were told of the deformity and discusses the duties of the speech-language pathologist and the psychologist in counseling the parents and the child. (Author/JDD)
Vanpoelvoorde, Leah; Shaughnessy, Michael F.
This paper reviews parents' emotional reactions following the birth of a cleft lip/palate child. It examines when parents were told of the deformity and discusses the duties of the speech-language pathologist and the psychologist in counseling the parents and the child. (Author/JDD)
Cadenat, H; Barthélémy, R; Izac, F; Clouet, M; Fabert, G
The writers have studied mandibular anomalies in a series of 20 surgically treated clefts. Anomalies of shape occur in one case out of two and are in the form of a mandible which is too long. Anomalies of position most often show a mandible in front of the maxillary and to the rear in comparison to the base of the skull.
Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan
Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.
Kong, Woo Keun; Hong, Seung-Koan
Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232
Cece, Hasan; Yildiz, Sema; Sogut, Ozgur; Hazar, Abdussamet; Sezen, Yusuf
Cardiac echinococcosis is extremely rare, and cysts are found mostly within the myocardium. Most cardiac hydatid cysts are located in the left ventricular wall. Only a few cases of isolated pericardial hydatid cysts have been reported. Echocardiography, computed tomography and magnetic resonance imaging are important diagnostic tools for the diagnosis of echinococcosis. Herein, we report a rare case of isolated pericardial hydatid cyst who presented to our emergency department with complaints of mid-sternal chest pain and shortness of breath.
Lithovius, Riitta H; Ylikontiola, Leena P; Harila, Virpi; Sándor, George K
The aim of this study was to determine the incidence of cleft lip and/or cleft palate in a population uniquely from Northern Finland. The records of a total of 214 cleft patients treated between 1998-2011 at the Oulu Cleft Lip and Palate Center at the University of Oulu were assessed on a retrospective basis. Data regarding cleft type, sex and side of cleft was collected and analyzed. Family history of clefting was investigated. Cleft palate (68.7%) was most frequently found, followed by cleft lip and palate (18.7%) and cleft lip with or without alveolus (12.6%). Cleft palate occurred more frequently in females (63.3%) and cleft lip and palate was more frequently found in males (62.5%). The left side was more frequently affected in both male and female patients. Left-sided clefts were observed in 82% of patients compared to right-sided clefts in 18%. A family history of clefting was detected in 20.1% of patients. The incidence of clefts in Northern Finland is higher than the corresponding incidence in other European countries. Cleft palate was the most frequent cleft type and it was more frequent in females. In males, cleft lip and palate was more frequent. The left side was more frequently affected in both genders. One fifth of the patients had a family history of clefts.
Yuce, Yucel; Uzun, Sennur; Aypar, Ulku
A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 μg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.
Christensen, A.K.; Hiroi, J.; Schultz, E.T.; McCormick, S.D.
The alewife (Alosa pseudoharengus) is a clupeid that undergoes larval and juvenile development in freshwater preceding marine habitation. The purpose of this study was to investigate osmoregulatory mechanisms in alewives that permit homeostasis in different salinities. To this end, we measured physiological, branchial biochemical and cellular responses in juvenile alewives acclimated to freshwater (0.5p.p.t.) or seawater (35.0p.p.t.). Plasma chloride concentration was higher in seawater-acclimated than freshwater-acclimated individuals (141mmoll -1 vs 134mmoll -1), but the hematocrit remained unchanged. In seawateracclimated individuals, branchial Na +/K +-ATPase (NKA) activity was higher by 75%. Western blot analysis indicated that the abundance of the NKA subunit and a Na+/K+/2Cl- cotransporter (NKCC1) were greater in seawater-acclimated individuals by 40% and 200%, respectively. NKA and NKCC1 were localized on the basolateral surface and tubular network of ionocytes in both acclimation groups. Immunohistochemical labeling for the cystic fibrosis transmembrane conductance regulator (CFTR) was restricted to the apical crypt of ionocytes in seawater-acclimated individuals, whereas sodium/hydrogen exchanger 3 (NHE3) labeling was present on the apical surface of ionocytes in both acclimation groups. Ionocytes were concentrated on the trailing edge of the gill filament, evenly distributed along the proximal 75% of the filamental axis and reduced distally. Ionocyte size and number on the gill filament were not affected by salinity; however, the number of lamellar ionocytes was significantly lower in seawater-acclimated fish. Confocal z-series reconstructions revealed that mature ionocytes in seawater-acclimated alewives occurred in multicellular complexes. These complexes might reduce paracellular Na + resistance, hence facilitating Na+ extrusion in hypo-osmoregulating juvenile alewives after seaward migration. ?? 2012. Published by The Company of Biologists Ltd.
Mahajan, Amit D; Manjunatha, Bhari Sharanesha; Khurana, Neha M; Shah, Navin
Intraoral swellings involving alveolar ridges in edentulous patients are clinically diagnosed as residual cysts, traumatic bone cysts, Stafne's jaw bone cavity, ameloblastoma and metastatic tumours of the jaw. This case report describes a residual cyst in a 68-year-old edentulous male patient which was enucleated and histopathologically confirmed as a unicystic ameloblastoma. PMID:25199192
Alen, Jose F.; Ramos, Ana; Lobato, Ramiro D.; Lagares, Alfonso
Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature. PMID:20174835
Woo, P. Y. C.; Sharr, M. M.
The clinical features of a cervical enterogenous cyst in a one-year-old boy mimicked those of an intracranial mass. Following removal of the cyst the neurological signs rapidly disappeared. The literature is reviewed from histological and clinical aspects and a classification of these cysts is proposed. ImagesFig. 1Fig. 2 PMID:7122385
Lehman, R A; Fieger, H G
A patient with an arachnoid cyst of the posteriro fossa experienced repeated episodes of transient right upper extremity numbness and weakness. Review of the literature indicates that arachnoid cysts of the posterior fossa and spinal canal as well as extradural spinal cysts may present with symptoms of transient neurological deficit which often suggest the diagnosis of multiple sclerosis.
Reichart, P A; Philipsen, H P
The inflammatory paradental cyst has been described as an entity in the WHO classification of odontogenic tumors and cysts (1992). It is mainly located at mandibular molars, in particular third molars of the lower jaw. Radiologically, involved molars show a circumscribed, mostly half-moon shaped translucency distal or distobuccal to the involved tooth. Patients frequently report episodes of infection (pericoronitis). The histological findings are identical to those of inflammatory radicular cysts. The inflammatory paradental cyst has been described infrequently in the international literature. There are no reports available in German. The aim of the present study was to present six of our own cases of inflammatory paradental cysts. Five men and one woman with an average age of 29.5 years were affected. In two cases paradental cysts occurred bilaterally. Three patients reported recurrent previous infections (pericoronitis). Radiologically, the typical translucency with clear demarcation distal to the third molars was observed. All of the third molars were vertically retained. Histologically, the inflammatory paradental cysts showed features identical to those of radicular cysts. The inflammatory paradental cyst is a clear indication for osteotomy of lower wisdom teeth. Postoperative complications or recurrences of the inflammatory paradental cysts have not been described. A correct clinical, radiological, and histopathological diagnosis of paradental cysts is mandatory, and more reports are needed in order to compile more information about relative frequency and pathogenesis of this cyst variant.
Cho, Sung Ik; Lee, Jung Hwan
Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision. PMID:27799997
Shahid, Kameron R; Hébert-Blouin, Marie-Noëlle; Amrami, Kimberly K; Spinner, Robert J
Rupture of simple (extraneural) cysts such as popliteal cysts (Baker's cysts) is a well-known occurrence. The purpose of this report is to introduce the similar occurrence of extraneural rupture of peroneal and tibial intraneural cysts in the knee region, describe the associated magnetic resonance imaging (MRI) findings, and identify risk factors. There was MRI evidence of rupture in 20 of 38 intraneural cases reviewed, mainly in the region of the fibular head and popliteal fossa. Ruptured intraneural cysts and simple cysts share these MRI findings: T2 hyperintense fluid within surrounding intermuscular fascial planes and enhancement with intravenous contrast consistent with inflammation. The mean maximal diameter of the ruptured intraneural cysts was statistically significantly smaller than that of the unruptured cysts. The authors believe that extraneural rupture of an intraneural cyst is due to increased intraarticular pressures transmitted within the cyst and/or elevated extrinsic pressure delivered to the cyst, such as by trauma, akin to the etiology of rupture of extraneural ganglion cysts.
Werner, Jens Ulrich; Lang, Gerhard K; Enders, Christian
Background Free-floating intraocular cysts may be found in the anterior chamber (FZV) and the vitreous (FZG). The first description of a cyst was 150 years ago, and they are considered to be ocular rarities. Materials and Methods The actual knowledge about FZV and FZG is shown on the basis of two exemplary patients. Results and Discussion Patient 1 had a FZV as an incidental finding which had a smooth surface, a slight pigmentation and was translucent. The ultrasound biomicroscopy revealed an echo-free interior space. Without the patient's discomfort and missing treatment indication, a watch-and-wait strategy was chosen. Cysts of the iris can be classified as primary and secondary cysts. Primary cysts of the iris can arise from the stroma as the pigment epithelium wherein it is believed that FZV descend from the pigment epithelium. Secondary cysts and FZV can be generated by tumors, inflammation, epithelial ingrowth, the use of eye-drops or intraocular foreign bodies. Patient 2 showed marked myopic fundus changes and an FZG with a yellowish-greenish surface; the transparency was reduced and the surface was not pigmented. The ultrasound examination also revealed an echo-free interior space. Clinical controls were advised. Congenital and acquired causes are discussed for the formation of FZG. FZG could originate from the pigment epithelium of the iris, but there are conflicting study results. Trauma, inflammation and chorioretinal diseases are considered as a reason for acquired causes of FZG. The genesis, especially of FZG, is still unclear. For the treatment of patients with FZV and FZG, it is important to know the potential causes to be able to make a therapeutic decision. High quality photographic and sonographic documentation is needed in the watch-and-wait strategy. Georg Thieme Verlag KG Stuttgart · New York.
Afnan, Jalil; Snuderl, Matija; Small, Juan
Aneurysmal bone cysts (ABCs) are benign, expansile, blood-filled, osteolytic lesions with internal septations that may be intraosseous or extraosseous. The cysts may cause local mass effect, and changes in the regional vascular supply necessitating intervention. A case of an intracranial, intradural ABC in a young male patient with progressively severe headaches is presented. This is only the third recorded intradural case, the majority of these rare lesions being extracranial and only a minute fraction intracranial. Copyright © 2015 Elsevier Inc. All rights reserved.
Arumugam, Prabhu; Fletcher, Natalie; Kyriakides, Charis; Mears, Lisa; Kocher, Hemant M.
Lymphoepithelial cyst (LEC) of the pancreas is an extremely rare, benign pancreatic cystic lesion that is difficult to differentiate preoperatively from other cystic pancreatic lesions. LEC may have malignant potential. Here, we describe a case of LEC of the pancreas – initially suspected to be a mucinous cyst neoplasm – in an elderly man presenting with abdominal pain, who went on to have a distal pancreatectomy and splenectomy. We also review the relevant literature and discuss implications for the diagnosis and management of this rare lesion. PMID:27403123
Bontempo, Nicholas A; Weiss, Arnold-Peter C
Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit.
Wissman, Robert D; England, Eric; Mehta, Kaushal; d'Heurle, Albert; Langenderfer, Eric; Mangine, Robert; Kenter, Keith
The trochlear cleft is a recently described vertically oriented, low-signal cartilage lesion centered in the trough of the trochlear cartilage. The purpose of our study was to determine the incidence of clefts in an at-risk group of athletes and correlate these findings with clinical and physical examination results. Sixteen female collegiate volleyball players consented to bilateral knee evaluations, which consisted of history, physical examination, and magnetic resonance (MR) imaging. Two fellowship-trained musculoskeletal radiologists reviewed each MR study by consensus. The trochlear cartilage was considered to be either normal, at risk of developing a cleft, or meeting the previously described criteria for clefts. The Fisher exact test was used for categorical variables, and the Mann-Whitney U test was used for nonparametric continuous variable. A total of 16 athletes (32 knees; 16 women; age range, 18-22 years; mean, 19.9 years) were enrolled in the study. Four knees (13%) in 3 athletes were diagnosed with a trochlear cleft; 6 knees (19%) in 4 athletes had clefts or were at risk of developing clefts. Among those players with unilateral cartilage lesions, 67% had contralateral abnormalities (P = 0.0783). Functional outcomes and physical examination findings were within normal limits for all athletes, with no difference noted between those with and without clefts. Elite athletes have a much higher incidence of trochlear clefts than the general population and are at risk of bilateral disease. Clefts are likely to be an incidental finding at MR imaging for unrelated symptoms.
Marius-Nunez, A L; Wasiak, D T
Among the representations of congenital malformations in Moche ceramic art, cranio-facial clefts have been portrayed in pottery found in Moche burials. These pottery vessels were used as domestic items during lifetime and funerary offerings upon death. The aim of this study was to examine archeological evidence for representations of cranio-facial cleft malformations in Moche vessels. Pottery depicting malformations of the midface in Moche collections in Lima-Peru were studied. The malformations portrayed on pottery were analyzed using the Tessier classification. Photographs were authorized by the Larco Museo.Three vessels were observed to have median cranio-facial dysraphia in association with midline cleft of the lower lip with cleft of the mandible. ML001489 portrays a median cranio-facial dysraphia with an orbital cleft and a midline cleft of the lower lip extending to the mandible. ML001514 represents a median facial dysraphia in association with an orbital facial cleft and a vertical orbital dystopia. ML001491 illustrates a median facial cleft with a soft tissue cleft. Three cases of midline, orbital and lateral facial clefts have been portrayed in Moche full-figure portrait vessels. They represent the earliest registries of congenital cranio-facial malformations in ancient Peru.
Kim, Su-Mi; Chung, Tae-Heum; Oh, Myoung-Soon; Kwon, Sung-Gul; Bae, Sung-Jin
Simple renal cyst is the most common cystic deformation found in adults. However, there were a few systematic Korean reports for the clinical symptoms and complications of simple renal cysts. The author's purpose was to determine the relationship between simple renal cysts diagnosed by abdominal ultrasonography and hypertension. Among 13,482 persons who took a routine physical examination at Ulsan University Hospital in 2002, 5,127 persons who took medical examinations again in 2010 were selected. We excluded persons who had renal cyst, hypertension, diabetes, liver cirrhosis, kidney disease, thyroid disease, and cancer in 2002. Analysis was conducted for 505 subjects with newly diagnosed simple renal cyst and 2,744 subjects without renal cyst in 2010. The simple renal cyst group was compared to a control group without renal cyst. Among 3,249 subjects, simple renal cyst and hypertension were newly diagnosed in 505 subjects and 503 subjects. The subjects who had simple renal cysts had significantly higher hypertension incidence (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.20 to 1.94). Significant hypertension incidence was observed especially when the subjects had cysts located on both kidneys (OR, 3.48; 95% CI, 2.12 to 5.71), two (OR, 3.08; 95% CI, 1.84 to 5.15) or more cysts (OR, 3.12; 95% CI, 1.38 to 7.04), and larger cysts more than 1 cm in diameter (OR, 1.55; 95% CI, 1.16 to 2.07). The presence of simple renal cysts was significantly positively related to the incidence of hypertension. Bilateral distribution, two or more number, and larger size than 1 cm diameter were the characteristics of simple renal cyst related to hypertension.
Kim, Su-Mi; Oh, Myoung-Soon; Kwon, Sung-Gul; Bae, Sung-Jin
Background Simple renal cyst is the most common cystic deformation found in adults. However, there were a few systematic Korean reports for the clinical symptoms and complications of simple renal cysts. The author's purpose was to determine the relationship between simple renal cysts diagnosed by abdominal ultrasonography and hypertension. Methods Among 13,482 persons who took a routine physical examination at Ulsan University Hospital in 2002, 5,127 persons who took medical examinations again in 2010 were selected. We excluded persons who had renal cyst, hypertension, diabetes, liver cirrhosis, kidney disease, thyroid disease, and cancer in 2002. Analysis was conducted for 505 subjects with newly diagnosed simple renal cyst and 2,744 subjects without renal cyst in 2010. The simple renal cyst group was compared to a control group without renal cyst. Results Among 3,249 subjects, simple renal cyst and hypertension were newly diagnosed in 505 subjects and 503 subjects. The subjects who had simple renal cysts had significantly higher hypertension incidence (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.20 to 1.94). Significant hypertension incidence was observed especially when the subjects had cysts located on both kidneys (OR, 3.48; 95% CI, 2.12 to 5.71), two (OR, 3.08; 95% CI, 1.84 to 5.15) or more cysts (OR, 3.12; 95% CI, 1.38 to 7.04), and larger cysts more than 1 cm in diameter (OR, 1.55; 95% CI, 1.16 to 2.07). Conclusion The presence of simple renal cysts was significantly positively related to the incidence of hypertension. Bilateral distribution, two or more number, and larger size than 1 cm diameter were the characteristics of simple renal cyst related to hypertension. PMID:25309704
Heyne, Galen W; Melberg, Cal G; Doroodchi, Padydeh; Parins, Kia F; Kietzman, Henry W; Everson, Joshua L; Ansen-Wilson, Lydia J; Lipinski, Robert J
The Hedgehog (Hh) signaling pathway mediates multiple spatiotemporally-specific aspects of brain and face development. Genetic and chemical disruptions of the pathway are known to result in an array of structural malformations, including holoprosencephaly (HPE), clefts of the lip with or without cleft palate (CL/P), and clefts of the secondary palate only (CPO). Here, we examined patterns of dysmorphology caused by acute, stage-specific Hh signaling inhibition. Timed-pregnant wildtype C57BL/6J mice were administered a single dose of the potent pathway antagonist vismodegib at discrete time points between gestational day (GD) 7.0 and 10.0, an interval approximately corresponding to the 15th to 24th days of human gestation. The resultant pattern of facial and brain dysmorphology was dependent upon stage of exposure. Insult between GD7.0 and GD8.25 resulted in HPE, with peak incidence following exposure at GD7.5. Unilateral clefts of the lip extending into the primary palate were also observed, with peak incidence following exposure at GD8.875. Insult between GD9.0 and GD10.0 resulted in CPO and forelimb abnormalities. We have previously demonstrated that Hh antagonist-induced cleft lip results from deficiency of the medial nasal process and show here that CPO is associated with reduced growth of the maxillary-derived palatal shelves. By defining the critical periods for the induction of HPE, CL/P, and CPO with fine temporal resolution, these results provide a mechanism by which Hh pathway disruption can result in "non-syndromic" orofacial clefting, or HPE with or without co-occurring clefts. This study also establishes a novel and tractable mouse model of human craniofacial malformations using a single dose of a commercially available and pathway-specific drug.
Bell, Jane C; Raynes-Greenow, Camille; Bower, Carol; Turner, Robin M; Roberts, Christine L; Nassar, Natasha
The reported birth prevalence of orofacial clefts (OFCs) varies considerably. This study describes the epidemiology of OFCs in an Australian population. We studied infants diagnosed with cleft lip, with or without cleft palate (CL±P), and cleft palate only (CPO) since 1980 and reported to the population based Western Australian Register of Developmental Anomalies. We calculated prevalence rates by sex, Aboriginal status, geographic location, and socio-economic status. Associations between clefts and folate availability, pregnancy characteristics, pregnancy outcomes, other congenital anomalies, and age at diagnosis were also investigated. From 1980 to 2009, 917 infants with CL±P (12.05 per 10,000) and from 1980 to 2004, 621 infants with CPO (10.12 per 10,000) were registered. Prevalence rates for CL±P and CPO were 1.9 and 1.3 times higher, respectively, for Aboriginal Australians. Additional anomalies were reported for 31% of infants with CL±P and for 61% with CPO; chromosomal anomalies and other specific diagnoses accounted for 46% and 66%, respectively, of those with CL±P and CPO with additional anomalies. Almost all (99.7%) children with CL±P were diagnosed before 1 year of age, but 12% of CPO diagnoses were made after 1 year of age; 94% of these diagnoses were of submucous clefts and bifid uvula. These data provide a picture of the prevalence of OFCs in WA since 1980, and provide a useful reference for OFC data in Australia and internationally. The quality and completeness of the WARDA data are high, reflected in high prevalence rates, and proportions of clefts occurring with other anomalies. Copyright © 2012 Wiley Periodicals, Inc.
Chetpakdeechit, Woranuch; Mohlin, Bengt; Persson, Christina; Hagberg, Catharina
To study the risks of having other birth defects in children born with an isolated cleft palate (iCP) when the length of the cleft was taken into account. The hypothesis was that a newborn with an extensive cleft lesion may have an increased risk of other birth defects compared to a child with a less extensive cleft of the palate. All Caucasian children with iCP born between 1975 and 2005 in the southwestern region of Sweden were included. Data were collected from standardized medical records and the length of the cleft was checked on the pre-surgical dental cast for each child. A total of 343 children were born with an iCP. The incidence was 0.64/1000 live births. Thirty-four percent of children with either a total or partial iCP had other birth defects. The risk was 1.7 times higher for a total compared to a partial iCP. The two most common birth defects were congenital heart disease and intellectual disability. Ear problems related to infections were registered in 43% of cases. Fifteen percent of the children had the Pierre Robin sequence, which was analyzed as a separate variable and not included as a birth defect. The length of the iCP was found to influence the risk of having another birth defect as the total palatal clefts were more often combined with other birth defects compared to partial clefts. Careful medical check-ups are important for newborns with iCP since they have increased risks of other birth defects.
Soares, Ciro Dantas; Gurgel, Alberto Costa; de Souza Júnior, Francisco de Assis; de Oliveira, Samila Neres; de Carvalho, Maria Goretti Freire; Oliveira, Hanieri Gustavo
Epidermoid cysts are common cystic lesions in the skin, ovaries, and testicles, but their occurrence in the oral cavity is uncommon. They consist of cysts delimited by a fibrous capsule without cutaneous annexes and are lined by stratified squamous epithelium. The differential diagnosis includes ranula, dermoid cysts, and lingual thyroid. Despite their benign presentation, these cysts can cause functional limitations, requiring special clinical attention for extensive lesions located in regions that preserve vital structures. This paper aims to report a case of epidermoid cyst in patient with swallowing and breathing difficulty, highlighting the clinical and surgical planning. PMID:26180645
Jung, Ki Tae; Lee, Hyun Young; Lim, Kyung Joon
Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.
Jung, Ki Tae; Lee, Hyun Young
Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst. PMID:22787551
Spinner, Robert J; Carmichael, Stephen W; Wang, Huan; Parisi, Thomas J; Skinner, John A; Amrami, Kimberly K
On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal branches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent
Sarig, Oren; Hass, Avraham; Oron, Amir
Ganglion cysts are considered the most common tumor of the wrist and hand. They are most common between the second and fourth decades of life. The most common anatomical location is the dorsal wrist. This article includes a general review of these cysts including symptoms, pathology and methods of diagnosis, as well as a review of these cysts in specific anatomic locations. The article also includes an updated review of the literature comparing open surgery vs. arthroscopic treatment. The authors believe that arthroscopic surgery of ganglion cysts will gain an important role in the treatment of these cysts.
Jabbari, Fatima; Reiser, Erika; Thor, Andreas; Hakelius, Malin; Nowinski, Daniel
Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting. Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up. Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up. Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning.
Wu, Jia; Liang, Shu; Shapiro, Linda; Tse, Raymond
The first part of this study validated an automated computer-based method of identifying the three-dimensional midfacial plane in children with unrepaired cleft lip. The purpose of this second part is to develop computer-based methods to quantify symmetry and to determine the correlation of these measures to clinical expectations. A total of 35 infants with unrepaired unilateral cleft lip and 14 infant controls. Six computer-based methods of quantifying symmetry were developed and applied to the three-dimensional images of infants with unilateral cleft lip before and after cleft lip repair and to those of controls. Symmetry scores for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed. Significant differences in symmetry scores were found between cleft types and found before and after surgery. Symmetry scores for infants with unilateral cleft lip approached those of controls after surgery, and there was a strong correlation with ranked cleft severity. Our computer-based three-dimensional analysis of nasolabial symmetry correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.
Jabbari, Fatima; Reiser, Erika; Thor, Andreas; Hakelius, Malin; Nowinski, Daniel
Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting. Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up. Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up. Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning. PMID:26923345
Moon, Sung Mo; Lee, Sang Min; Kang, Haeyoun; Choi, Hye Jeong
Abstract Subcutaneous bronchogenic cysts have been described rarely, particularly among adolescents. Only a few reports have described the ultrasonographic features of bronchogenic cysts, characterizing them as nonspecific cystic masses with or without internal echogenic foci or debris. Therefore, it is hard to differentiate subcutaneous bronchogenic cysts from other subcutaneous cystic tumors ultrasonographically. We report a case of presternal subcutaneous bronchogenic cyst in an 18-year-old man with unusual ultrasonographic findings. Ultrasonography revealed a small, oval, cystic mass containing a well-circumscribed, heterogeneously hypoechoic, egg-shaped lesion in the dependent portion of the mass within the subcutaneous fat layer overlying the sternum. Surgical excision was performed, and the cystic mass was diagnosed as a bronchogenic cyst. On pathological examination, the internal, heterogeneously hypoechoic, ball-like lesion was found to be mucous material within the cyst. To our knowledge, this is the first reported case of a presternal subcutaneous bronchogenic cyst presenting with a ball-like lesion inside of the cyst. This unusual ultrasonographic feature can be a clue to the diagnosis of subcutaneous bronchogenic cyst. In conclusion, if an anechoic cyst containing an internal, well-circumscribed, hypoechoic ball-like lesion is seen in the presternal subcutaneous fat layer, subcutaneous bronchogenic cyst should be considered in the differential diagnosis of subcutaneous cystic masses. PMID:28151916
Tolarová, Marie M; Poulton, Donald; Aubert, Maryse M; Oh, HeeSoo; Ellerhorst, Thomas; Mosby, Terezie; Tolar, Miroslav; Boyd, Robert L
There is no doubt modern genetics have greatly influenced our professional and personal lives during the last decade. Uncovering genetic causes of many medical and dental pathologies is helping to narrow the diagnosis and select a treatment plan that would provide the best outcome. Importantly, having an understanding of multifactorial etiology helps direct our attention toward prevention. We now understand much better our own health problems. In some cases, we can modify our lifestyle and diet in order to prevent "environmental factors" from triggering the mutated genes inherited from our parents. Good examples are diabetes and cardiovascular diseases. If we realize we might have inherited genes for cardiovascular problems from several ancestors who had heart attacks, we already know that these genes will make us only "susceptible" for disease. Those who exercise, watch one's weight, diet, and carefully monitor one's lifestyle will very likely--though possessing "susceptibility genes"--stay healthier and, maybe, will never experience any cardiovascular problems. In principle, the same applies for craniofacial anomalies, especially for nonsyndromic cleft lip and palate. One needs to understand genetic and environmental causes of nonsyndromic orofacial clefts in order to prevent them. With all this in mind, the Pacific Craniofacial Team and Cleft Prevention Program have been established at the Department of Orthodontics, University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco. A partnership with Rotaplast International, Inc., has made it possible for the faculty, orthodontic residents, and students to participate in 27 multidisciplinary cleft medical missions in underdeveloped and developing countries by donating professional and educational services, and, last but not least, by collecting valuable data and specimens to further research. A significant number of research studies, including 15 master of science theses, have been accomplished in
Chaiyabud, Pradit; Suwanpratheep, Kitti
Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. The cysts are relatively rare and most of them are asymptomatic. Some Tarlov cysts can exert pressure on nerve elements resulting in pain, radiculopathy and even multiple radiculopathy of cauda equina. There is no consensus on the appropriate therapeutic options of Tarlov cysts. The authors present a case of two sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. The neurological deficits were recovered and had not recurred after a follow-up period of nine months. The literature was reviewed and discussed. This is the first reported case in Thailand.
Adam, David P.; Mahood, Albert D.
Many Chrysophyte algae produce morphologically distinctive, siliceous, microscopic cysts during a resting stage of their life cycles; these cysts are often preserved in sediments. Scanning electron microscopy and Nomarski optics permit much more detailed observation of these cysts than was heretofore possible. We have used an ecologic and biogeographic approach to study the distribution of cyst forms in sediments and have established that many cyst types are found only in specific habitats, such as montane lakes, wet meadows, ephemeral ponds, and Sphagnum bogs. In the samples we have studied, cysts seem to be most common in fluctuating fresh-water habitats of low to moderate pH and some winter freezing. Numerous taxonomic problems have yet to be resolved. We believe that chrysophyte cysts have the potential to become a useful tool for both modern environmental assessments and paleoecological studies of Cenozoic fresh-water lacustrine deposits.
Dede, Kristóf; Mersich, Tamás; Faludi, Sándor; Blans, Beáta; Salamon, Ferenc; Jakab, Ferenc
Mesenteric cysts are rare intraabdominal tumors, which cause plain symptoms. Despite the modern imaging techniques, the correct preoperative diagnosis is difficult. The optimal treatment is surgical excision of the cysts with open surgery, laparoscopy, or even retroperitoneoscopy. Surgical excision needs to be considered in case of complaints, growing cyst, or suspicion of malignancy. Indications for urgent surgery treatment are: bleeding, volvulus, torquation or ileus. Most frequently, mesenterial cysts are diagnosed during the operation of an unknown palpable abdominal cystic resistance. We present a case of a 32-year-old female patient with a jejunal mesenteric cyst, treated by laparoscopic resection. Postoperative period was uneventful, and after an early discharge the patient's recovery was free of symptoms. Histopathological examination revealed a benign cyst. We conclude that laparoscopic resection of abdominal cysts with unknown origin is a safe operation and can be recommended.
Lee, Doreen L P; Madhuvrata, Priya; Reed, Malcolm W; Balasubramanian, Saba P
A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. A case report of a patient with mesenteric cyst is presented. In addition, a systematic review was performed of English language literature on chylous mesenteric cysts in adult humans. Of the 18 articles included in the review, there were 19 cases of chylous mesenteric cysts reported. Male to female ratio was 1.4:1 with a median age of 46 years. A preoperative diagnosis of mesenteric cyst was made in four patients based on computed tomography. All patients underwent surgery and there were no reports of recurrence on follow up. Chylous mesenteric cyst is a rare entity that needs to be recognized whenever a preliminary diagnosis of intra-abdominal cystic mass is made. Copyright © 2013. Published by Elsevier Taiwan.
Tsuji, Kaname; Wato, Masahiro; Hayashi, Teruyoshi; Yasuda, Norihiro; Matsushita, Takumi; Ito, Tomohiko; Gamoh, Shoko; Yoshida, Hiroaki; Tanaka, Akio; Morita, Shosuke
The epithelial lining of odontogenic keratocysts exhibits either parakeratosis or orthokeratosis. In 2005, the WHO classified odontogenic keratocysts with parakeratosis as keratocystic odontogenic tumors (KCOT). Odontogenic keratocysts with orthokeratosis were not classified as odontogenic tumors, but instead referred to as orthokeratinized odontogenic cysts (OOC). To clarify the difference between these two lesions, we investigated their biological characteristics using immunohistochemical studies for cytokeratins (CK) in KCOT and OOC as well as in dentigerous cysts (DC), radicular cysts (RC) and dermoid cysts (DMC). We examined twenty-five cases of KCOT, fifteen cases each of OOC, DC and RC, and ten cases of DMC. We studied the immunohistochemical expression of CK10, 13, 17 and 19. To evaluate the immunohistochemical staining pattern, we divided the epithelial lining of the lesions into three layers (surface layer: su, spinous layer: sp, basal layer: ba). For CK10, most OOC and DMC specimens of su and sp were positive. For CK13 and 19, most KCOT, DC and RC specimens of su and sp were positive. For CK17, most KCOT specimens of su and sp were positive. The percentages of total CK expression of su and sp, and ba of CK19 differed significantly between the lesions (P < 0.001). These results support the hypothesis that OOC originate from not the odontogenic apparatus, but the oral epithelial component.
Aksakal, Nihat; Kement, Metin; Okkabaz, Nuri; Altuntaş, Yunus Emre; Öncel, Mustafa
The hydatid disease caused by Echinococcus granulosus is an endemic parasitic disease affecting several Mediterranean countries. Echinococcal cysts are mostly located in the liver and the lung, but the disease can be detected anywhere in the body. In this study, we present uncommon extrahepatic localizations of primary hydatid disease. Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between 2004 and 2010 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung were enrolled in the study. Eight patients with extrahepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in the scapular region, spleen, pancreas, lumbosacral region and gluteal muscle. Surgical techniques were partial or total cystectomy with or without tube drainage. Splenectomy was performed for splenic hydatid disease and partial pericystectomy, Roux-en-Y cystojejunostomy, cholecystectomy and T-tube drainage for pancreatic hydatid disease. There were no complications or mortality in the postoperative period. Hydatid cyst should be considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique should be planned according to the location of the cyst. PMID:27436938
Ozogul, Bunyami; Kisaoglu, Abdullah; Atamanalp, Sabri Selcuk; Ozturk, Gurkan; Aydinli, Bulent; Yıldırgan, Mehmet İlhan; Kantarcı, A Mecit
Hydatid cyst disease, which is endemically observed and an important health problem in our country, involves the spleen at a frequency ranking third following the liver and the lungs. In this study, we aimed to evaluate the efficacy and results of management in splenic hydatid cysts. The demographic data, localization, diagnosis, treatment methods, and the length of postoperative hospital stay of patients with splenic hydatid cysts in a 12-year period were evaluated retrospectively. Seventeen cases were evaluated. Among these, 13 were females and four were males. Seven had solitary splenic involvement, eight had involvement of both the spleen and the liver, and two had multiple organ involvement. Ten had undergone splenectomy, one had undergone distal splenectomy, and the remaining cases had undergone different surgical procedures. The patients had received albendazole treatment in the pre- and postoperative period. One patient had died secondary to hypernatremia on the first postoperative day. The clinical picture in splenic hydatid cysts, which is seen rarely, is usually asymptomatic. The diagnosis is established by ultrasonography and abdominal CT. Although splenectomy is the standard mode of treatment, spleen-preserving methods may be used.
Moreno, Lina M.; Mansilla, Maria Adela; Bullard, Steve A.; Cooper, Margaret E.; Busch, Tamara D.; Machida, Junichiro; Johnson, Marla K.; Brauer, David; Krahn, Katherine; Daack-Hirsch, Sandy; L'Heureux, Jamie; Valencia-Ramirez, Consuelo; Rivera, Dora; López, Ana Maria; Moreno, Manuel A.; Hing, Anne; Lammer, Edward J.; Jones, Marilyn; Christensen, Kaare; Lie, Rolv T.; Jugessur, Astanand; Wilcox, Allen J.; Chines, Peter; Pugh, Elizabeth; Doheny, Kim; Arcos-Burgos, Mauricio; Marazita, Mary L.; Murray, Jeffrey C.; Lidral, Andrew C.
Nonsyndromic orofacial clefts are a common complex birth defect caused by genetic and environmental factors and/or their interactions. A previous genome-wide linkage scan discovered a novel locus for cleft lip with or without cleft palate (CL/P) at 9q22–q33. To identify the etiologic gene, we undertook an iterative and complementary fine mapping strategy using family-based CL/P samples from Colombia, USA and the Philippines. Candidate genes within 9q22–q33 were sequenced, revealing 32 new variants. Concurrently, 397 SNPs spanning the 9q22–q33 2-LOD-unit interval were tested for association. Significant SNP and haplotype association signals (P = 1.45E − 08) narrowed the interval to a 200 kb region containing: FOXE1, C9ORF156 and HEMGN. Association results were replicated in CL/P families of European descent and when all populations were combined the two most associated SNPs, rs3758249 (P = 5.01E − 13) and rs4460498 (P = 6.51E − 12), were located inside a 70 kb high linkage disequilibrium block containing FOXE1. Association signals for Caucasians and Asians clustered 5′ and 3′ of FOXE1, respectively. Isolated cleft palate (CP) was also associated, indicating that FOXE1 plays a role in two phenotypes thought to be genetically distinct. Foxe1 expression was found in the epithelium undergoing fusion between the medial nasal and maxillary processes. Mutation screens of FOXE1 identified two family-specific missense mutations at highly conserved amino acids. These data indicate that FOXE1 is a major gene for CL/P and provides new insights for improved counseling and genetic interaction studies. PMID:19779022
Hinev, Alexander; Anakievski, Deyan
The aim of this study was to report our experience with the llaparoscopic transperitoneal treatment of simple renal cysts, to analyze the immediate and long-term clinical outcomes, and to evaluate the efficacy and safety of this miniinvasive surgical technique. Between 2009 and 2014 we diagnosed and treated a total of 48 patients with symptomatic simple renal cysts. The diagnosis was set up by ultrasound (US) and/or computed tomography (CT) examination. All cases were managed by transperitoneal laparoscopic cyst decortication. Demographic data, perioperative blood loss, duration of operative procedure, length of hospital stay and peri- and postoperative complications were analyzed. Follow-up included clinical examination and renal US, performed at 3-monthly intervals during the first year and yearly thereafter. Patient age ranged from 32 to 68 years (mean age 52.4 years). 27 (56.2%) of the patients were males and 21 (43.8%)--females. 42 (87.5%) of the cysts were peripheral, and 6 (12.5%)-peripelvic; 28 (58.3%) were localized to the left and 20 (41.7%)--to the right; and they ranged by size from 5 to 30 cm (mean 9.8 cm). 45 (93.8%) of the cysts were identified as category I, and only 3 (6.2%)--as category II, according to the Bosniak classification. None of the cases required conversion to open surgery. There were no peri- and postoperative complications. The average duration of the laparoscopic procedure was 55 min, and the average perioperative blood loss--50 mL. All patients had negative cytological and histological findings indicative for malignancy. The follow-up period ranged from 5 to 52ain months (average--25.4 months). In 47 cases (97.9%) exellent therapeutic results were reported: complete relief of clinical symptoms, fast recovery of physical activity and patient quality of life. There were three recurrences (6.2%) met in patients with multiple cysts, but only one of them required repeated surgery. Laparoscopic transperitoneal decortication is a
Raposo-Amaral, Cassio Eduardo; Raposo-Amaral, Cesar Augusto
The organization and management of specialized cleft lip and palate centers in developing countries are challenging because of the lack of financial resources devoted to the national health care system. The treatment of cleft lip and palate is of low priority for health care and budgets; however, gradual progress is possible. As an example of how care might be improved in the developing world, we suggest guidelines to strengthen the local cleft lip and palate centers in Brazil based on the ideal geographic distribution of cleft centers around the country, to achieve the following objectives: first, avoid patient's migration; second, facilitate patient's adherence; third, focus on a global and continuous multidisciplinary treatment; and fourth, avoid indiscriminate opening of nonprepared cleft lip and palate centers in our country. This ideal scenario would put the cleft lip and palate health attention on the right path in Brazil.
de Castro Monteiro Loffredo, L; Freitas, J A; Grigolli, A A
To estimate the prevalence of oral clefts in Brazil categorized by etiology and geographical region. Case reports of oral cleft in newborns in the period 1975 - 1994 were included in the study. Data was collected using the morbidity certificates of the Hospital de Reabilitação de Anomalias Craniofaciais (Craniofacial Abnormalities Rehabilitation Hospital), Ministry of Health data (Datasus), and Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Census Bureau). There were 16,853 new cases of oral clefts, with a total prevalence of 0.19 per 1,000 births, and there was an increased prevalence every five years. The highest prevalence were observed in the Midwest, southeast, and south regions. As for the studied categories, cleft lip (or the cleft of lip and palate) was seen in 74% of the cases and isolated cleft palate was seen in 26% of them.
Li, Qian; Chen, Ling; Gao, Yanli; Yan, Hui; Zhou, Bei; Li, Jun
Plasma microRNAs (miRNAs) have recently emerged as a new class of regulatory molecules that influence many biological functions. However, the expression profile of plasma microRNAs in nonsyndromic cleft palate (NSCP) or nonsyndromic cleft lip with cleft palate (NSCLP) remains poorly investigated. In this study, we used Agilent human miRNA microarray chips to monitor miRNA levels in three NSCP plasma samples (mixed as the CP group), three NSCLP plasma samples (mixed as the CLP group) and three normal plasma samples (mixed as the Control group). Six selected plasma miRNAs were validated in samples from an additional 16 CP, 33 CLP and 8 healthy children using qRT-PCR. Using Venn diagrams, distinct and overlapping dysregulated miRNAs were identified. Their respective target genes were further assessed using gene ontology and pathway analysis. The results show that distinct or overlapping biological processes and signalling pathways were involved in CP and CLP. Our study showed that the common key gene targets reflected functional relationships to the Notch, Wnt, phosphatidylinositol and Hedgehog signalling pathways. Further studies should examine the mechanism of the potential target genes, which may provide new avenues for future clinical prevention and therapy. PMID:27863433
Denny, A D; Kinney, T
We have developed a strategy for concurrent correction of multiple secondary clefting deformities based on the model proposed by Henderson and Jackson  which combines several cleft-related procedures. We have expanded this concept significantly to include as many as eleven procedures. The selected procedures are dictated individually by patients' needs. The constellation of corrective cleft-related surgeries has been given the name "cleft cluster" in the interest of simplicity. We are reporting on our experience with 85 consecutive patients using this approach. All patients in this series received bone grafting of the alveolar cleft as the primary procedure, plus multiple additional procedures as necessary. None of the patients reported received primary lip or palate surgery by the authors. The average number of procedures performed was 7.2. The average hospitalization was 4.1 days. The patients have been followed from 1 to 7 yrs. The fistula recurrence rate was 8%. Average patient age was 16.8 yrs with a range of 8 to 54 yrs. This approach eliminates multiple hospitalizations and outpatient procedures, allows flexibility to individualize patient care, provides consistent results, and is cost-effective.
Muhammad, Joseph Kamal; Akhtar, Shakeel; Abu Al Nassar, Hiba; Al Khoury, Nabil
The reconstructive options for large expansive cystic lesion affecting the jaws are many. The first stage of treatment may involve enucleation or marsupialization of the cyst. Attempted reconstruction of large osseous defects arising from the destruction of local tissue can present formidable challenges. The literature reports the use of bone grafts, free tissue transfer, bone morphogenic protein and reconstruction plates to assist in the healing and rehabilitation process. The management of huge mandibular cysts needs to take into account the preservation of existing intact structures, removal of the pathology and the reconstructive objectives which focus both on aesthetic and functional rehabilitation. The planning and execution of such treatment requires not only the compliance of the patient and family but also their assent as customers with a voice in determining their surgical destiny. The authors would like to report a unique case of a huge solitary bone cyst that had reduced the ramus, angle and part of the body of one side of the mandible to a pencil-thin-like strut of bone. A combination of decompression through marsupialization, serial packing, and the fabrication of a custom made obturator facilitated the regeneration of the myo-osseous components of the masticatory unit of this patient. Serial CT scans showed evidence of concurrent periosteal and endosteal bone formation and, quite elegantly, the regeneration of the first branchial arch components of the right myo-osseous masticatory complex. The microenvironmental factors that may have favored regeneration of these complex structures are discussed.
Ruegg, Teresa A; Cooper, Margaret E; Leslie, Elizabeth J; Ford, Matthew D; Wehby, George L; Deleyiannis, Frederic W B; Czeizel, Andrew E; Hecht, Jacqueline T; Marazita, Mary L; Weinberg, Seth M
Chronic ear infections are a common occurrence in children with orofacial clefts involving the secondary palate. Less is known about the middle ear status of individuals with isolated clefts of the lip, although several studies have reported elevated rates of ear infection in this group. The purpose of this retrospective study was to test the hypothesis that chronic ear infections occur more frequently in isolated cleft lip cases (n = 94) compared with controls (n = 183). A questionnaire was used to obtain information on history of chronic ear infection. The association between ear infection status (present/absent) and cleft lip status (cleft lip case/control) was tested using both chi-square and logistic regression. The reported occurrence of chronic ear infection was significantly greater in cleft lip cases (31%) compared with unaffected controls (11%). After adjusting for age and sex, having a cleft lip increased the odds of being positive for ear infection by a factor greater than 3 (odds ratio = 3.698; 95% confidence interval = 1.91 to 7.14). Within cleft lip cases, there was no difference in the occurrence of ear infection by defect laterality or by the type of clefting present in the family history. Although velopharyngeal insufficiency was present in 18.4% of our cleft lip sample, there was no statistical association between ear infection and abnormal speech patterns. These results may have potential implications both for the clinical management of isolated cleft lip cases and for understanding the etiology of orofacial clefting.
Howe, B.J.; Cooper, M.E.; Vieira, A.R.; Weinberg, S.M.; Resick, J.M.; Nidey, N.L.; Wehby, G.L.; Marazita, M.L.
Children with oral clefts show a wide range of dental anomalies, adding complexity to understanding the phenotypic spectrum of orofacial clefting. The evidence is mixed, however, on whether the prevalence of dental anomalies is elevated in unaffected relatives and is mostly based on small samples. In the largest international cohort to date of children with nonsyndromic clefts, their relatives, and controls, this study characterizes the spectrum of cleft-related dental anomalies and evaluates whether families with clefting have a significantly higher risk for such anomalies compared with the general population. A total of 3,811 individuals were included: 660 cases with clefts, 1,922 unaffected relatives, and 1,229 controls. Dental anomalies were identified from in-person dental exams or intraoral photographs, and case-control differences were tested using χ2 statistics. Cases had higher rates of dental anomalies in the maxillary arch than did controls for primary (21% vs. 4%, P = 3 × 10−8) and permanent dentitions (51% vs. 8%, P = 4 × 10−62) but not in the mandible. Dental anomalies were more prevalent in cleft lip with cleft palate than other cleft types. More anomalies were seen in the ipsilateral side of the cleft. Agenesis and tooth displacements were the most common dental anomalies found in case probands for primary and permanent dentitions. Compared with controls, unaffected siblings (10% vs. 2%, P = 0.003) and parents (13% vs. 7%, P = 0.001) showed a trend for increased anomalies of the maxillary permanent dentition. Yet, these differences were nonsignificant after multiple-testing correction, suggesting genetic heterogeneity in some families carrying susceptibility to both overt clefts and dental anomalies. Collectively, the findings suggest that most affected families do not have higher genetic risk for dental anomalies than the general population and that the higher prevalence of anomalies in cases is primarily a physical consequence of the cleft
Peter, J P; Chinsky, R R; Fisher, M J
The patterns of social integration of adults with primary and secondary groups were evaluated for 196 adult cleft subjects, their 190 siblings and 209 random controls. Results indicated that cleft adults tended to rely on the extended family for mutual aid and social activities. They also participated less frequently in voluntary associations and relied on a few one-to-one friendships. Social activities tended to be that of informal visiting patterns. While it would be inaccurate to characterize the cleft adult family as grossly different from other American families, they are a definable population experiencing some degree of limitation associated with having a cleft.
Klein, Tobias; Kellner, Maximilian; Boemers, Thomas Michael; Mack-Detlefsen, Birte
Sternal cleft is a rare congenital malformation with little more than 100 cases published worldwide. Incomplete sternal clefting in a female newborn is the most frequent form seen. First-line treatment is the surgical defect closure in the neonatal period. Presurgical examination has to focus on common associated malformations, in particular cardiac defects. The surgical repair of sternal cleft itself shows satisfying functional and cosmetic results with low complication rates. We present the case of a 4-month-old male infant with a superior sternal cleft. PMID:26788449
Hviid, Anders; Mølgaard-Nielsen, Ditte
Background The association between the risk of orofacial clefts in infants and the use of corticosteroids during pregnancy is unclear from the available evidence. We conducted a nationwide cohort study of all live births in Denmark over a 12-year period. Methods We collected data on all live births in Denmark from Jan. 1, 1996, to Sept. 30, 2008. We included live births for which information was available from nationwide health registries on the use of corticosteroids during pregnancy, the diagnosis of an orofacial cleft and possible confounders. Results There were 832 636 live births during the study period. Exposure to corticosteroids during the first trimester occurred in 51 973 of the pregnancies. A total of 1232 isolated orofacial clefts (i.e., cleft lip, cleft palate, or cleft lip and cleft palate) were diagnosed within the first year of life, including 84 instances in which the infant had been exposed to corticosteroids during the first trimester of pregnancy. We did not identify any statistically significant increased risk of orofacial clefts associated with the use of corticosteroids: cleft lip with or without cleft palate, prevalence odds ratio (OR) 1.05 (95% confidence interval [CI] 0.80–1.38]; cleft palate alone, prevalence OR 1.23 (95% CI 0.83–1.82). Odds ratios for risk of orofacial clefts by method of delivery (i.e., oral, inhalant, nasal spray, or dermatologic and other topicals) were consistent with the overall results of the study and did not display significant heterogeneity, although the OR for cleft lip with or without cleft palate associated with the use of dermatologic corticosteroids was 1.45 (95% CI 1.03–2.05). Interpretation Our results add to the safety information on a class of drugs commonly used during pregnancy. Our study did not show an increased risk of orofacial clefts with the use of corticosteroids during pregnancy. Indepth investigation of the pattern of association between orofacial clefts and the use of dermatologic
Vanrenterghem, L; Joly, B; Podvin, A; Poupart; Bayart, M
The authors report three cases of Median Cleft of the upper lip, a clinical entity really deserving the term of "hare lip", a very ancient denomination who dates back to the Tang Dynasty and unfairly used to describe the usual lateral clefts of the lip. The denominations of "true" and "false" median cleft lips recovering respectively such different embryopathic realities as clefts of the median element with varying degrees of vertical separation and as agenesis of the fronto-nasal process accompanied with cerebral anomalies are no more used now. Median clefts of the upper lip can be included in the "neurocristopathies" by less or more precocious dysneurulation of the fronto-nasal process creating anomalies from various single midline defects of the upper lip of our three cases, to associated midline defects like in the Median Cleft face syndrome (fronto-nasal dysplasia) described by De Myer and Sedano to holoprosencephaly (arhinencephaly), which are rarely associated.
Marazita, Mary L
Orofacial clefts (OFCs)--primarily cleft lip and cleft palate--are among the most common birth defects in all populations worldwide, and have notable population, ethnicity, and gender differences in birth prevalence. Interest in these birth defects goes back centuries, as does formal scientific interest; scientists often used OFCs as examples or evidence during paradigm shifts in human genetics, and have also used virtually every new method of human genetic analysis to deepen our understanding of OFC. This review traces the evolution of human genetic investigations of OFC, highlights the specific insights gained about OFC through the years, and culminates in a review of recent key OFC genetic findings resulting from the powerful tools of the genomics era. Notably, OFC represents a major success for genome-wide approaches, and the field is poised for further breakthroughs in the near future.
Marazita, Mary L.
Orofacial clefts (OFCs)—primarily cleft lip and cleft palate—are among the most common birth defects in all populations worldwide, and have notable population, ethnicity, and gender differences in birth prevalence. Interest in these birth defects goes back centuries, as does formal scientific interest; scientists often used OFCs as examples or evidence during paradigm shifts in human genetics, and have also used virtually every new method of human genetic analysis to deepen our understanding of OFC. This review traces the evolution of human genetic investigations of OFC, highlights the specific insights gained about OFC through the years, and culminates in a review of recent key OFC genetic findings resulting from the powerful tools of the genomics era. Notably, OFC represents a major success for genome-wide approaches, and the field is poised for further breakthroughs in the near future. PMID:22703175
Mundwiler-Pachlatko, Esther; Beck, Hans-Peter
Plasmodium falciparum, the causative agent of malaria, completely remodels the infected human erythrocyte to acquire nutrients and to evade the immune system. For this process, the parasite exports more than 10% of all its proteins into the host cell cytosol, including the major virulence factor PfEMP1 (P. falciparum erythrocyte surface protein 1). This unusual protein trafficking system involves long-known parasite-derived membranous structures in the host cell cytosol, called Maurer’s clefts. However, the genesis, role, and function of Maurer’s clefts remain elusive. Similarly unclear is how proteins are sorted and how they are transported to and from these structures. Recent years have seen a large increase of knowledge but, as yet, no functional model has been established. In this perspective we review the most important findings and conclude with potential possibilities to shed light into the enigma of Maurer’s clefts. Understanding the mechanism and function of these structures, as well as their involvement in protein export in P. falciparum, might lead to innovative control strategies and might give us a handle with which to help to eliminate this deadly parasite. PMID:24284172
Tollefson, Travis T; Shaye, David; Durbin-Johnson, Blythe; Mehdezadeh, Omid; Mahomva, Leonard; Chidzonga, Midion
To evaluate the prevalence and unmet need for cleft lip-cleft palate reconstructive surgery by using incidence. Our hypotheses were that the age of presentation to screening clinics will decrease between 2006 and 2012, and the geospatial distribution of cases will expand to a more rural catchment area. Longitudinal cross-sectional/geospatial distribution study. An online, secure database was created from intake forms for children with cleft lip-cleft palate (N=604) in Zimbabwe (2006-2012). Univariate analysis was completed. A linear regression model was fitted to test the time trend of a child's age at the time of presentation. Unique patient addresses (n=411) were matched. Maps presenting cleft diagnosis and presentation year were created with geographic information systems (GIS) software. The median age of presentation was greater for isolated cleft palate (4.2 years, n=106) than isolated cleft lip (1.5 years, n=251) and cleft lip-cleft palate (2.0 years, n=175). Cleft lip cases were mostly left sided with equal gender distribution. The overall age of presentation remained stable (P=.83). The age of children with isolated cleft palate decreased by 0.8 years per surgical trip (P=.01), suggesting the prevalence of unrepaired cleft palate is decreasing due to local and visiting surgeons. The catchment area extended to a less populous area, but clustered around Harare and Bulawayo. This study gives Zimbabwe-specific evidence that supports reports of the persistent burden of disease requiring attention. The GIS software provided data for the primary needs assessment, which will direct communication to healthcare providers and prospective patients outside of the current catchment area. 3 © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Shao, Qinghua; Chen, Zhengxi; Yang, Yang; Chen, Zhenqi
Objective : To evaluate the effects of lip repair on maxillofacial development of patients with unilateral cleft lip with or without cleft palate. Design : Retrospective. Patients : A total of 75 patients were recruited, including 38 surgical patients with complete unilateral cleft lip and alveolus and 37 patients with complete unilateral cleft lip and palate who had lip but not palate repair. As controls, 38 patients with no cleft were selected. All subjects were divided according to two growth stages: before the pubertal peak (GS1) and after the pubertal peak (GS2). Interventions : Lateral cephalograms of all subjects were obtained. Main Outcome Measures : Cephalograms were analyzed and compared in the study and control groups. Results : The patients with unilateral cleft lip and palate in both GS1 and GS2 demonstrated an almost normal maxillary and mandibular growth with retroclined maxillary incisors. The patients with unilateral cleft lip and palate showed a shorter length of maxilla, a more clockwise-rotated mandible, and retroclined maxillary incisors. Conclusions : There was an almost normal maxillary and mandibular growth but retroclined maxillary incisors in patients with cleft lip with or without cleft palate who had received lip repair only, indicating that lip repair may not have a negative impact on the maxillofacial development and influences only the inclination of the maxillary incisors. The shorter anterior-posterior maxillary length and larger gonial angle in patients with unilateral cleft lip and palate compared with those in patients with unilateral cleft lip and alveolus suggest that these variations in maxillary and mandibular growth may be a consequence of the cleft itself.
Wang, Hong; Zhang, Tianxiao; Wu, Tao; Hetmanski, Jacqueline B; Ruczinski, Ingo; Schwender, Holger; Liang, Kung Yee; Murray, Tanda; Fallin, M Daniele; Redett, Richard J; Raymond, Gerald V; Jin, Sheng-Chih; Chou, Yah-Huei Wu; Chen, Philip Kuo-Ting; Yeow, Vincent; Chong, Samuel S; Cheah, Felicia S H; Jee, Sun Ha; Jabs, Ethylin W; Scott, Alan F; Beaty, Terri H
Background : Isolated, nonsyndromic cleft lip with or without cleft palate is a common human congenital malformation with a complex and heterogeneous etiology. Genes coding for fibroblast growth factors and their receptors (FGF/FGFR genes) are excellent candidate genes. Methods : We tested single-nucleotide polymorphic markers in 10 FGF/FGFR genes (including FGFBP1, FGF2, FGF10, FGF18, FGFR1, FGFR2, FGF19, FGF4, FGF3, and FGF9) for genotypic effects, interactions with one another, and with common maternal environmental exposures in 221 Asian and 76 Maryland case-parent trios ascertained through a child with isolated, nonsyndromic cleft lip with or without cleft palate. Results : Both FGFR1 and FGF19 yielded evidence of linkage and association in the transmission disequilibrium test, confirming previous evidence. Haplotypes of three single-nucleotide polymorphisms in FGFR1 were nominally significant among Asian trios. Estimated odds ratios for individual single-nucleotide polymorphic markers and haplotypes of multiple markers in FGF19 ranged from 1.31 to 1.87. We also found suggestive evidence of maternal genotypic effects for markers in FGF2 and FGF10 among Asian trios. Tests for gene-environment (G × E) interaction between markers in FGFR2 and maternal smoking or multivitamin supplementation yielded significant evidence of G × E interaction separately. Tests of gene-gene (G × G) interaction using Cordell's method yielded significant evidence between single-nucleotide polymorphisms in FGF9 and FGF18, which was confirmed in an independent sample of trios from an international consortium. Conclusion : Our results suggest several genes in the FGF/FGFR family may influence risk for isolated, nonsyndromic cleft lip with or without cleft palate through distinct biological mechanisms.
Parray, Fazl Q; Sherwani, Afak Yusuf; Dangroo, Sajad Ahmad; Bisati, Rafia Aziz; Malik, Nighat Shaffi
Bronchogenic cysts frequently occur in the mediastinum. They may be rarely encountered in the abdomen and retroperitoneum. Bronchogenic cysts can in fact mimic hydatid cysts. We report a case of retroperitoneal bronchogenic cyst below the right hemidiaphragm mimicking a hydatid cyst of the liver in a 30-year-old female.
Parray, Fazl Q.; Sherwani, Afak Yusuf; Dangroo, Sajad Ahmad; Bisati, Rafia Aziz; Malik, Nighat Shaffi
Bronchogenic cysts frequently occur in the mediastinum. They may be rarely encountered in the abdomen and retroperitoneum. Bronchogenic cysts can in fact mimic hydatid cysts. We report a case of retroperitoneal bronchogenic cyst below the right hemidiaphragm mimicking a hydatid cyst of the liver in a 30-year-old female. PMID:22606600
Tiwari, Charu; Shah, Hemanshi; Desale, Jayesh; Waghmare, Mukta
Vaginal cysts are rare, particularly in the newborn. They usually present as one of these three entities in the newborn: paraurethral cysts (Skene duct cysts), Gartner duct cysts (mesonephric ductal remnants) or a covered ectopic ureter. Abdominal ultrasound should always be included in the clinical evaluation in search of renal anomalies. We report two cases of Gartner cysts in neonates.
Bosnjak, Jelena; Budisić, Mislav; Azman, Drazen; Strineka, Maja; Crnjaković, Miljenko; Demarin, Vida
Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. Pineal cysts usually have no clinical implications and remain asymptomatic for years. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agreement that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.
Weber, Manuel; Schlittenbauer, Tilo; Moebius, Patrick; Büttner-Herold, Maike; Ries, Jutta; Preidl, Raimund; Geppert, Carol-Immanuel; Neukam, Friedrich W; Wehrhan, Falk
Apical periodontitis can appear clinically as apical granulomas or radicular cysts. There is evidence that immunologic factors are involved in the pathogenesis of both pathologies. In contrast to radicular cysts, the dentigerous cysts have a developmental origin. Macrophage polarization (M1 vs M2) is a main regulator of tissue homeostasis and differentiation. There are no studies comparing macrophage polarization in apical granulomas, radicular cysts, and dentigerous cysts. Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray (TMA) of the 87 consecutive specimens was created, and CD68-, CD11c-, CD163-, and MRC1-positive macrophages were detected by immunohistochemical methods. TMAs were digitized, and the expression of macrophage markers was quantitatively assessed. Radicular cysts are characterized by M1 polarization of macrophages while apical granulomas show a significantly higher degree of M2 polarization. Dentigerous cysts have a significantly lower M1 polarization than both analyzed periapical lesions (apical granulomas and radicular cysts) and accordingly, a significantly higher M2 polarization than radicular cysts. Macrophage cell density in dentigerous cysts is significantly lower than in the periapical lesions. The development of apical periodontitis towards apical granulomas or radicular cysts might be directed by macrophage polarization. Radicular cyst formation is associated with an increased M1 polarization of infiltrating macrophages. In contrast to radicular cysts, dentigerous cysts are characterized by a low macrophage infiltration and a high degree of M2 polarization, possibly reflecting their developmental rather than inflammatory origin. As M1 polarization of macrophages is triggered by bacterial antigens, these results underline the need for sufficient bacterial clearance during endodontic treatment to prevent a possible M1 macrophage-derived stimulus for radicular cyst
Jones, K D; Sutton, C J G
To estimate the recurrence rate of chocolate cysts 3 to 12 months after ablative laparoscopic surgery. The secondary outcome measure was the need for a repeat surgical procedure. Prospective cohort study (Canadian Task Force classification II-2). Tertiary referral center for laparoscopic treatment of endometriosis. Seventy-three consecutive women with chocolate cysts larger than 2 cm. Laparoscopy at which cyst capsules were vaporized or coagulated with the potassium-titanyl-phosphate (KTP) laser or Bicap bipolar diathermy. There were 96 cysts (23 bilateral) in 73 women (1 patient underwent a two-stage procedure). Their mean diameter was 4.79 cm (range 2-25 cm). The median r-AFS score was 56 (range 22-128), and 55 patients (75.3%) had stage 4 disease. The KTP laser was used in 50 women (68.5%) and bipolar diathermy in 23 (31.5%). At 12 months, 5 patients (6.9%) were lost to follow-up, and 12 had a recurrent cyst. Therefore, the cyst recurrence rate/patient was 16.4% (12/73) and the rate/cyst was 12.5% (12/96). Women who had recurrences were significantly more likely to have bilateral cysts, 7/12 (58.3%), than those with single cysts, 16/61 (26.2%, p =0.032). Bicap bipolar diathermy was associated with a recurrence rate of 20.8% (5/24). The rate in women who had KTP laser ablation was 14.3% (7/49, NS). Eighteen patients had repeat operations (including on recurrent cysts). Therefore the reoperation rate was 24.6% (18/73). No major surgical complications occurred. One woman had a postoperative wound infection after a second procedure to remove an ovary with a recurrent cyst. Laparoscopic cyst fenestration followed by capsule ablation is safe and effective treatment for preventing recurrence of chocolate cysts.
Schnell, Patrick; Bartlett, Cynthia H; Solomon, Benjamin J; Tassell, Vanessa; Shaw, Alice T; de Pas, Tommaso; Lee, Soo-Hyun; Lee, Geon Kook; Tanaka, Kaoru; Tan, Weiwei; Tang, Yiyun; Wilner, Keith D; Safferman, Allan; Han, Ji-Youn
An apparent causal association between crizotinib treatment and renal cyst development emerged during clinical trials in anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer (NSCLC). Serious adverse event (SAE) reports of renal cysts from a safety database of 1375 patients from four clinical trials were reviewed. A blinded, retrospective, independent radiologic review (IRR) was performed using scans from patients on study for ≥6 months in three clinical trials; risk factors for renal cyst development were assessed. Among 17 patients with renal cysts reported as SAEs, evidence of invasion into adjacent structures was noted in seven patients, with no evidence of malignancy found. These patients generally did not require dose reductions, none required permanent crizotinib discontinuation due to this AE, and most continued treatment with clinical benefit. In the blinded IRR, among 255 crizotinib-treated patients, 22%, 3%, and 2% had preexisting simple cysts, complex cysts, or both, respectively. At the 6-month tumor assessment, 9% of all patients had acquired new cysts, and 2% of patients with preexisting cysts had developed new cysts and enlargements (>50%) of preexisting simple cysts. Asians appeared to have an increased risk of developing new cysts on treatment; Koreans in particular had 5.18 times higher odds of developing cysts than non-Asians (95% confidence interval, 1.51–17.78; P = 0.05). Crizotinib treatment appears to be associated with an increased risk of development and progression of renal cysts in patients with ALK-positive NSCLC. While close monitoring is recommended, dosing modification was not generally necessary, allowing patients to remain on crizotinib treatment. PMID:25756473
Schnell, Patrick; Bartlett, Cynthia H; Solomon, Benjamin J; Tassell, Vanessa; Shaw, Alice T; de Pas, Tommaso; Lee, Soo-Hyun; Lee, Geon Kook; Tanaka, Kaoru; Tan, Weiwei; Tang, Yiyun; Wilner, Keith D; Safferman, Allan; Han, Ji-Youn
An apparent causal association between crizotinib treatment and renal cyst development emerged during clinical trials in anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). Serious adverse event (SAE) reports of renal cysts from a safety database of 1375 patients from four clinical trials were reviewed. A blinded, retrospective, independent radiologic review (IRR) was performed using scans from patients on study for ≥ 6 months in three clinical trials; risk factors for renal cyst development were assessed. Among 17 patients with renal cysts reported as SAEs, evidence of invasion into adjacent structures was noted in seven patients, with no evidence of malignancy found. These patients generally did not require dose reductions, none required permanent crizotinib discontinuation due to this AE, and most continued treatment with clinical benefit. In the blinded IRR, among 255 crizotinib-treated patients, 22%, 3%, and 2% had preexisting simple cysts, complex cysts, or both, respectively. At the 6-month tumor assessment, 9% of all patients had acquired new cysts, and 2% of patients with preexisting cysts had developed new cysts and enlargements (>50%) of preexisting simple cysts. Asians appeared to have an increased risk of developing new cysts on treatment; Koreans in particular had 5.18 times higher odds of developing cysts than non-Asians (95% confidence interval, 1.51-17.78; P = 0.05). Crizotinib treatment appears to be associated with an increased risk of development and progression of renal cysts in patients with ALK-positive NSCLC. While close monitoring is recommended, dosing modification was not generally necessary, allowing patients to remain on crizotinib treatment. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Duskova, Marketa; Sosna, Bohuslav; Sukop, Andrej
Men with clefts often have limited or even missing moustache growth in scar areas or in the upper lip prolabium. However the histological testing showed the absence or at least the inactive form of androgenic receptor in hair follicle of cleft site, transplantation of autologous grafts harvested from hair was successful in all six cases either into scars or the prolabium. A more natural effect was achieved by using micrografts. The positive reaction of patients proved there is a need for detailed treatment in highly outgoing individuals.
Neiswanger, Katherine; Weinberg, Seth M; Rogers, Carolyn R; Brandon, Carla A; Cooper, Margaret E; Bardi, Kathleen M; Deleyiannis, Frederic W B; Resick, Judith M; Bowen, A'Delbert; Mooney, Mark P; de Salamanca, Javier Enríquez; González, Beatriz; Maher, Brion S; Martin, Rick A; Marazita, Mary L
Nonsyndromic cleft lip+/-cleft palate is a complex disease with a wide phenotypic spectrum; occult defects of the superior orbicularis oris muscle may represent the mildest subclinical form of the lip portion of the phenotype. This study used high-resolution ultrasonography to compare the frequency of discontinuities in the OO muscle in 525 unaffected relatives of individuals with nonsyndromic cleft lip+/-cleft palate versus 257 unaffected controls. OO muscle discontinuities were observed in 54 (10.3%) of the non-cleft relatives, compared to 15 (5.8%) of the controls-a statistically significant increase (P=0.04). Male relatives had a significantly higher rate of discontinuities than male controls (12.0% vs. 3.2%; P=0.01); female relatives also had a higher rate of discontinuities than female controls, but the increase was not statistically significant (8.9% vs. 7.4%; P=0.56). These data confirm the hypothesis that subepithelial OO muscle defects are a mild manifestation of the cleft lip phenotype. Identification of subepithelial OO muscle defects may be important in a clinical setting, as a means of providing more accurate recurrence risk estimates to relatives in cleft families. Furthermore, the expansion of the cleft lip+/-cleft palate phenotypic spectrum should improve the power of genetic studies. Copyright (c) 2007 Wiley-Liss, Inc.
Tang, Cheng-Hao; Lee, Tsung-Han
Almost the whole life cycle of the grass puffer (Takifugu niphobles) occurs in seawater (SW), but it is also sometimes found in fresh water (FW) rivers. This study aims to evaluate the effects of FW exposure on the stress, osmoregulatory, and physiological responses of the grass puffer. The grass puffers were captured from a local wetland and acclimated to SW (35‰) or FW in the laboratory. In the stress responses, plasma glucose concentrations and the abundances of hepatic and branchial heat shock proteins were higher in the FW group than in the SW group. FW acclimation led to a significant increase in the protein abundance and the specific activity of branchial Na(+)/K(+)-ATPase (NKA). Immunochemical staining showed that the NKA immunoreactive (NKIR) cells of the FW and SW puffer were distributed mainly in gill filaments. Although the number of NKIR cells was similar in the two groups, the protein levels of proliferating cell nuclear antigen (PCNA) of nuclear fractions were elevated in the gills of the FW puffer. The induction of gill PCNA might contribute to cell proliferation which would maintain the amount of NKIR cells or repair DNA when exposed to FW, an osmotically stressful environment. Hence, activation of stress responses would provide the osmoprotection associated with FW adaptation of the grass puffer. Changes of branchial NKA expression and activity for osmoregulatory adjustment were required for stable blood osmolality and muscle water content. Based on our findings, the grass puffer was suggested to be a euryhaline teleost with SW preference.
Kadam, Manjushree; Kadam, Dinesh; Bhandary, Sanath; Hukkeri, Rajesh Y.
Objective: Natal/neonatal teeth are reported to be more common among clefts and congenital anomalies. Data exclusively among clefts is sparse. The aim was to evaluate prevalence of natal teeth among cleft lip and palate neonates and review the causes, presentation, associated anomalies, complications and management. Materials and Methods: Out of 641operated patients, records of 151 infants with cleft lip and palate with less than three months of age presented to the department of plastic and reconstructive surgery from 2005 to 2011 were reviewed. Out of which 107 were unilateral complete lip and palate (ULCP), 15 bilateral cleft lip and isolated cleft palate constituted 29. Results: Three patients among the studied records showed neonatal teeth. Two had paired central mandibular incisor teeth along with associated other anomalies and one had a single maxillary neonatal tooth. All were present in unilateral cleft lip and none of the bilateral or isolated cleft palate infants showed neonatal teeth. The overall incidence of neonatal teeth was 1.98% and 2.8% in unilateral Cleft lip. Conclusion: Our study supports the incidence of 2% natal teeth among UCLP. Involvement of mandibular central incisors in contrast to the notion that maxillary alveolus is more commonly affected suggest that it is not only the anatomical disturbance but also all those possible common multifactorial etiological factors contributing to the congenital anomalies as such. Natal/neonatal teeth are rather under-diagnosed and reported than a rare phenomenon and the prevalence is higher in certain population. Riga-Fede disease unlikely to be seen in clefts with neonatal teeth due to anatomical factors. The extraction of non mobile tooth if necessary can be done during the primary surgery for the cleft lip. PMID:24163556
Kadam, Manjushree; Kadam, Dinesh; Bhandary, Sanath; Hukkeri, Rajesh Y
Natal/neonatal teeth are reported to be more common among clefts and congenital anomalies. Data exclusively among clefts is sparse. The aim was to evaluate prevalence of natal teeth among cleft lip and palate neonates and review the causes, presentation, associated anomalies, complications and management. Out of 641operated patients, records of 151 infants with cleft lip and palate with less than three months of age presented to the department of plastic and reconstructive surgery from 2005 to 2011 were reviewed. Out of which 107 were unilateral complete lip and palate (ULCP), 15 bilateral cleft lip and isolated cleft palate constituted 29. Three patients among the studied records showed neonatal teeth. Two had paired central mandibular incisor teeth along with associated other anomalies and one had a single maxillary neonatal tooth. All were present in unilateral cleft lip and none of the bilateral or isolated cleft palate infants showed neonatal teeth. The overall incidence of neonatal teeth was 1.98% and 2.8% in unilateral Cleft lip. Our study supports the incidence of 2% natal teeth among UCLP. Involvement of mandibular central incisors in contrast to the notion that maxillary alveolus is more commonly affected suggest that it is not only the anatomical disturbance but also all those possible common multifactorial etiological factors contributing to the congenital anomalies as such. Natal/neonatal teeth are rather under-diagnosed and reported than a rare phenomenon and the prevalence is higher in certain population. Riga-Fede disease unlikely to be seen in clefts with neonatal teeth due to anatomical factors. The extraction of non mobile tooth if necessary can be done during the primary surgery for the cleft lip.
Sharp, Gemma C; Ho, Karen; Davies, Amy; Stergiakouli, Evie; Humphries, Kerry; McArdle, Wendy; Sandy, Jonathan; Davey Smith, George; Lewis, Sarah J; Relton, Caroline L
Epigenetic data could help identify risk factors for orofacial clefts, either by revealing a causal role for epigenetic mechanisms in causing clefts or by capturing information about causal genetic or environmental factors. Given the evidence that different subtypes of orofacial cleft have distinct aetiologies, we explored whether children with different cleft subtypes showed distinct epigenetic profiles. In whole-blood samples from 150 children from the Cleft Collective cohort study, we measured DNA methylation at over 450,000 sites on the genome. We then carried out epigenome-wide association studies (EWAS) to test the association between methylation at each site and cleft subtype (cleft lip only (CLO) n = 50; cleft palate only (CPO) n = 50; cleft lip and palate (CLP) n = 50). We also compared methylation in the blood to methylation in the lip or palate tissue using genome-wide data from the same 150 children and conducted an EWAS of CLO compared to CLP in lip tissue. We found four genomic regions in blood differentially methylated in CLO compared to CLP, 17 in CPO compared to CLP and 294 in CPO compared to CLO. Several regions mapped to genes that have previously been implicated in the development of orofacial clefts (for example, TBX1, COL11A2, HOXA2, PDGFRA), and over 250 associations were novel. Methylation in blood correlated with that in lip/palate at some regions. There were 14 regions differentially methylated in the lip tissue from children with CLO and CLP, with one region (near KIAA0415) showing up in both the blood and lip EWAS. Our finding of distinct methylation profiles in different orofacial cleft (OFC) subtypes represents a promising first step in exploring the potential role of epigenetic modifications in the aetiology of OFCs and/or as clinically useful biomarkers of OFC subtypes.
Luiza, Andrea; Noronha de Góis, Diego; Santos, Jadson Alípio Santana de Sousa; Brito de Oliveira, Rosany Larissa; Ferreira da Silva, Luiz Carlos
Introduction The nonsyndromic orofacial cleft is the fourth most common birth defect, but in Brazil, data about the cleft epidemiology are not accurate. Objective This study aimed to describe the epidemiologic characteristics of oral cleft cases at Specialized Society Attending Cleft Patient in Sergipe State. Methods Data were obtained from patients' medical records in relation to the following characteristics: age; gender; race; origin; cleft type; additional malformations and/or complications; prenatal accomplishment; treatment applied. For diagnosis analysis, it was noted if mothers had received prenatal care and if they had ultrasonography performed and if the cleft was viewed in it. Results We observed a prevalence of male gender (54%). Age between 0 and 4 years old was most prevalent (53%), and pheoderma race was observed in 47%. Transincisive foramen cleft was found in 52.3% of the individuals. The prevalence of pre- and transincisive foramen cleft was higher in men (66.3 and 55.7%), women accounted for 65.0% of postincisive foramen, and atypical facial cleft (0.3%) occurred in one case. Associated malformations and complications were present in 12% of patients. Prenatal care was reported by 48% of the mothers. Conclusion In this study male gender was the most affected, and 0 to 4 years was the most frequent age group. Transincisive foramen cleft type was most frequently encountered. Prenatal care was reported by most mothers. So, this study found that early treatment is a reality in SEAFESE (Service Specializing in Cleft Care of Sergipe), and consequently the chances of successful integration of the child to society will be better. PMID:25992043
Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh
ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017
Lee, H-J; Kim, P-T; Jeon, I-H; Kyung, H-S; Ra, I-H; Kim, T-K
Osteophyte excision is a mainstay of treatment for mucous cyst combined with Heberden's node in a distal interphalangeal joint or in an interphalangeal joint of the thumb. The aim of this study was to evaluate the results of osteophyte excision without cyst excision for the treatment of a mucous cyst combined with Heberden's node. The medical records of 37 patients (42 cases) with a mucous cyst with Heberden's node were retrospectively reviewed. Thirty-eight of 40 cases with available pre-operative simple radiographs showed evidence of joint arthrosis. A T-shaped skin incision of the joint capsule between the extensor tendon and lateral collateral ligament was used. Osteophyte excision without cyst excision was performed. All cysts, except one, regressed without recurrence or a skin complication after osteophyte excision, but eight cases showed post-operative pain and loss of range of motion. Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger.
Kizilay, Zahir; Yilmaz, Ali; Gurcan, Sevilay; Berber, Osman; Ozsunar, Yelda; Eliyatkın, Nuket
The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.
Garg, Mandeep K; Sharma, Madhurima; Gulati, Ajay; Gorsi, Ujjwal; Aggarwal, Ashutosh N; Agarwal, Ritesh; Khandelwal, Niranjan
Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored. PMID:27358685
Bone scintigrams with Tc-99m radiopharmaceuticals of 25 aneurysmal bone cysts showed abnormal activity in every case. In 22 cases, the activity was correlated with the true pathologic extent of the lesions; only three exhibited a false-positive extended pattern of uptake beyond the true tumor margins. Sixteen scintigrams (64%) revealed increased uptake, chiefly around the periphery of the lesions, with less activity in their centers. This feature could not be explained simply by the cystic nature of the lesions, since aneurysmal bone cysts may contain considerable fibrous tissue septa containing trabeculae of reactive new bone. However, there was no correlation between any specific anatomic or histologic pattern and the intensity and pattern of abnormal scintigraphic activity.
Ligh, Cassandra A; Fox, Justin P; Swanson, Jordan; Yu, Jason W; Taylor, Jesse A
This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient
Deshmukh, Jeevanand; Shrivastava, Ratika; Bharath, Kashetty Panchakshari; Mallikarjuna, Rachappa
Radicular cysts are inflammatory odontogenic cysts of tooth bearing areas of the jaws. Most of these lesions involve the apex of offending tooth and appear as well-defined radiolucencies. Owing to its clinical characteristics similar to other more commonly occurring lesions in the oral cavity, differential diagnosis should include dentigerous cyst, ameloblastoma, odontogenic keratocyst, periapical cementoma and Pindborg tumour. The present case report documents a massive radicular cyst crossing the midline of the palate. Based on clinical, radiographical and histopathological findings, the present case was diagnosed as an infected radicular cyst. The clinical characteristics of this cyst could be considered as an interesting and unusual due to its giant nature. The lesion was surgically enucleated along with the extraction of the associated tooth; preservation of all other teeth and vital structures, without any postoperative complications and satisfactory healing, was achieved. PMID:24792022
Adam, D.P.; Mahood, A.D.
Many chrysophyte algae produce morphologically distinctive, siliceous, microscopic cysts during a resting stage of their life cycles; these cysts are often preserved in sediments. Scanning electron microscopy and Nomarski optics permit much more detailed observation of these cysts than was heretofore possible. Many cyst types are found only in specific habitats, such as montane lakes, wet meadows, ephemeral ponds, and Sphagnum bogs. In the samples studied, cysts seem to be most common in fluctuating fresh-water habitats of low to moderate pH and some winter freezing. Chrysophyte cysts have the potential to be a useful tool for modern environmental assessments and paleoecological studies of Cenozoic fresh-water lacustrine deposits. -from Authors
Fernández-López, Antonio-José; Candel-Arenas, Marifé; González-Valverde, Francisco-Miguel; Luján-Martínez, Delia; Medina-Manuel, Esther; Albarracín Marín-Blázquez, Antonio
Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess. We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage. Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.
Yoshida, Noriko; Ikeda, Yasuhiro; Murakami, Yusuke; Nakatake, Shunji; Tachibana, Takashi; Notomi, Shoji; Hisatomi, Toshio; Ishibashi, Tatsuro
To determine the prevalence of vitreous cysts in patients with retinitis pigmentosa (RP). We retrospectively reviewed the charts of 435 consecutive patients diagnosed as having typical RP. Vitreous cysts were diagnosed in 37 eyes of 28 patients with RP (13 males and 15 females; mean age 47.0 ± 19.8 years; range 15-79 years), for an overall prevalence of 6.4%. The cysts were observed bilaterally in nine of the patients (32.1%). Among these 28 patients, 11 (39.3%) were younger than 40 years. In all, 81.8% of the vitreous cysts were detected around the optic nerve head. We demonstrated that the prevalence of vitreous cysts was 6.4% in patients with RP. These cysts were considered to be asymptomatic.
Lipsett, Pamela A; Pitt, Henry A
Biliary cystic disease is uncommon in Asia and very rare in Europe and the Americas. Patients with biliary cysts may present as infants, children, or adults. When patients present as adults, they are more likely to have stones in the gallbladder, common duct, or intrahepatic ducts and to present with biliary colic, acute cholecystitis, cholangitis, or gallstone pancreatitis. With increasing age at presentation, the risks of intrahepatic strictures and stones, segmented hepatic atrophy/hypertrophy, secondary biliary cirrhosis, portal hypertension, and biliary malignancy all increase significantly. Factors to be considered when performing surgery on patients with biliary cystic disease include: (1) age, (2) presenting symptoms, (3) cyst type, (4) associated biliary stones, (5) prior biliary surgery, (6) intrahepatic strictures, (7) hepatic atrophy/hypertrophy, (8) biliary cirrhosis, (9) portal hypertension, and (10) associated biliary malignancy. In general, regardless of age, presenting symptoms, biliary stones, prior surgery or other secondary problems, surgery should include cholecystectomy and excision of extrahepatic cyst(s). With respect to the distal bile duct, the surgical principle should be excision of a portion of the intrapancreatic bile duct with care to not injure the pancreatic duct or a long common channel. Resection of the pancreatic head should be reserved for patients with an established malignancy. With respect to the intrahepatic ducts, surgery should be individualized depending on whether (1) both lobes are involved, (2) strictures and stones are present, (3) cirrhosis has developed, or (4) an associated malignancy is localized or metastatic. When the liver is not cirrhotic, hepatic parenchyma should be preserved even when strictures and stones are present. If cirrhosis is advanced, hepatic transplantation may be indicated, but this sequence of events is unusual. If a malignancy has developed, oncologic principles should be followed. Whenever
Bulut, Emel; Baş, Burcu; Dinçer, Duygu; Günhan, Ömer
Glandular odontogenic cyst is a rare developmental odontogenic cysts of the jaws having an aggressive behavior. The most common site of occurrence is the anterior mandible, and it is widely seen in middle-aged people. It is suggested that trauma could be a precipitating factor for its occurrence. This article presents the diagnosis and treatment of a case of glandular odontogenic cyst at anterior maxilla that occurred at the same localization of a traumatic bone cyst, 5 years after its management.
Patibandla, M. R.; Yerramneni, Vamsi Krishna; Mudumba, Vijaya S.; Manisha, Nukavarapu; Addagada, Gokul Chowdary
The incidence of epidermoid tumors is between 1% and 2% of all intracranial tumors. The usual locations of epidermoid tumor are the parasellar region and cerebellopontine angle, and it is less commonly located in sylvian fissure, suprasellar region, cerebral and cerebellar hemispheres, and lateral and fourth ventricles. Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns, and those located in the brain stem are rare. These epidermoids contain cheesy and flaky white soft putty like contents. Epidermoid cysts are very slow growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from remnants of epidermal elements during closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the third and fifth weeks of embryonic life. We are presenting an interesting case of intrinsic brainstem epidermoid cyst containing milky white liquefied material with flakes in a 5-year-old girl. Diffusion-weighted imaging is definitive for the diagnosis. Ideal treatment of choice is removal of cystic components with complete resection of capsule. Although radical resection will prevent recurrence, in view of very thin firmly adherent capsule to brainstem, it is not always possible to do complete resection of capsule without any neurological deficits. PMID:27366244
Sen, Ramesh Kumar; Goyal, Tarun; Tripathy, Sujit Kumar; Chakraborty, Soumya
Perineural cysts are common and usually detected incidentally during magnetic resonance imaging of the lumbosacral spine. Treatment is indicated only when the cyst is symptomatic. We report one such patients presented with cauda equina syndrome and another with low back pain with claudication. They underwent excision and duraplasty; both motor and sensory fibres were carefully separated from the cyst wall using a nerve root retractor and penfield. There was no nerve root damage or neural deficit. Symptoms were relieved postoperatively.
Kumar, Raj; Singhal, Namit
A 15-year-old female presented with primary amenorrhea and delayed onset of secondary sexual characteristics. Earlier she was operated for endoscopic third ventriculostomy (ETV) for a tense suprasellar arachnoid cyst with obstructive hydrocephalus. MRI revealed recurrence of hydrocephalus. Hormonal levels were suggestive of hypogonadism and deficiency of growth hormone. She was operated for fenestration of cyst. In this case, suprasellar arachnoid cyst presented with delayed puberty, which is unusual.
Mendelson, D.S.; Rose, J.S.; Efremidis, S.C.; Kirschner, P.A.; Cohen, B.A.
Four patients with mediastinal masses are described. CT examinations demonstrated masses of high attenuation, and solid masses were suspected. At thoracotomy each patient had a cystic mass containing a brownish, turbid, mucoid material. The pathologic diagnosis in each case was a bronchogenic cyst. The possibility of such a cyst should not be excluded because of a high CT number, which reflects the turbid contents of the cyst.
Leveque, S; Derrey, S; Martinaud, O; Freger, P; Proust, F
Glial cysts of the pineal gland are usually benign and asymptomatic. They develop from the pineal parenchyma and contain liquid. The diagnosis is made by magnetic resonance imaging. In contrast large cysts can be symptomatic due to compression of the aqueduct of Sylvius, compression of the midbrain tectum or mass effect in the posterior fossa. We report the case of a symptomatic cyst treated by an endoscopic procedure.
Rabii, Redouane; Mezzour, Mohamed Hicham; Essaki, Hicham; Fekak, Hamid; Joual, Abdenbi; Meziane, Fethi
A multivesicular hydatid cyst was removed from the left kidney of a 26-year-old woman by retroperitoneal laparoscopy to avoid contamination of the abdominal cavity. A scolicidal agent (20% hypertonic saline) was injected around the kidney initially and then instilled into the cyst after the contents had been evacuated. There were no complications and no anaphylactic shock. This appears to be the first reported case of treatment of renal hydatid cyst by laparoscopy.
Arun, Sumitha; Kumar, Manish; Ross, Benjamin Jeyanth
Bronchogenic cyst (BC) is a rare congenital malformation of the lung. Most patients remain asymptomatic until adulthood while some are symptomatic in the first few years of life. However, symptoms in newborn period are rare. We report a case of a 3-day-old preterm baby with respiratory distress diagnosed as congenital lobar emphysema on chest X-ray. A CT scan revealed a mediastinal cyst causing obstructive lobar emphysema. The cyst was excised and pathological examination was suggestive of BC.
Bonde, V; Muzumdar, D; Goel, A
Arachnoid cysts are rare lesions occurring anywhere in the cerebrospinal axis. The sylvian fissure remains the most favoured site for their occurrence, followed by cerebellopontine angle, suprasellar, and quadrigeminal cisterns. Retroclival arachnoid cysts are very rare. We report a retroclival arachnoid cyst with bilateral cerebellopontine angle extensions with hemifacial spasm in a 26-year-old woman. The patient underwent surgery and her hemifacial spasm improved.
Matsumoto, Hiroaki; Matsumoto, Shigeo; Miki, Takanori; Miyaji, Yuki; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Yoshida, Yasuhisa; Yamaura, Ikuya; Natsume, Shigeatsu; Yoshida, Kozo
A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.
Choi, Hang Suk; Choi, Hyun Gon; Kim, Soon Heum; Park, Hyung Jun; Shin, Dong Hyeok; Jo, Dong In; Kim, Cheol Keun
Background The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type. Methods The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed. Results The difference between the preoperative and intraoperative values were -0.1±0.3 cm3 (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2±0.3 cm3 (P<0.05). Conclusions Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm3 in the presence of a cleft palate. PMID:23094242
Barbosa, M M; Rocha, C M G; Katina, T; Caldas, M; Codorniz, A; Medeiros, C
To establish the prevalence of congenital heart diseases (CHDs) in cleft patients, the type of cleft and the presence of a syndrome were coded in 220 patients. A Doppler echocardiogram with color-flow mapping (DE) was obtained in all patients. Mean age was 112.0 +/- 101.2 months (range, 1-576 months), and 56.8% (125) were males. Cleft lip and palate occurred in 144 patients (65.5%), cleft lip in 40 (18.2%), and cleft palate in 36 (16.4%). Cleft palates were more frequent among females. Twenty-four CHDs were diagnosed in 21 of 220 patients (9.5%): 7 mitral valve prolapses, 6 atrial septal defects, 4 patent ductus arteriosus, 3 ventricular septal defects, 2 cases of tetralogy of Fallot, 1 pulmonary stenosis, and 1 bicuspid aortic valve. The presence of CHD did not correlate with the type of cleft. Syndromes occurred in 28 patients (12.7%), and this association was higher among patients with a cleft palate.
Ramdial, Shaal; Pillay, Desigan; Madaree, Anil
A three day old neonate was referred to our department with a problem of a sternal cleft. Sternal clefts are often associated with a myriad of other abnormalities ranging from mild to severe. We present our experience with such a problem, and review the current literature concerning it. PMID:27853697
Klein, Marsha Dunn
This pamphlet on feeding techniques for children who have cleft lip and palate emphasizes the role of the parent as part of a team involving many specialists. The pamphlet begins with explanations of complete and incomplete separations of the lip, unilateral and bilateral cleft lips, corrective surgical procedures, etc. The importance of weight…
Mazaheri, Y; Ranjbar, R; Ghadiri, A R; Afsahr, F Saberi; Nejad, S Goorani; Mahabady, M Khaksary; Afrough, M; Karampoor, R; Tavakoli, A
Congenital palatal defects are common in animals but there is only one report of water buffalo has been recorded in Iran. One died male water buffalo calf was examined after hysterotomy operation. At necropsy findings, brachygnathia, palate cleft and small lungs were diagnosed. It is the second report of water buffalo cleft palate in Iran.
Maarse, Wiesje; Boonacker, Chantal W B; Breugem, Corstiaan C; Kon, Moshe; Manten, Gwendolyn T R; Mink van der Molen, Aebele B
Our aim is to introduce and validate a new oral cleft classification system based on prenatal ultrasound for use by professionals in daily practice. During a 3-year period (2011-2014), all cases of prenatal oral cleft diagnosed by ultrasound were retrospectively reviewed. A new prenatal ultrasound classification system was introduced. For the purpose of validation, prenatal ultrasound images of oral cleft types were described according to the new classification system and were compared with postnatal findings by reviewing medical records. A total of 103 fetuses with oral cleft were identified by ultrasound. The mean gestation time at detection was 20.4 weeks (95% confidence intervals: 20.0-20.7). The association between oral cleft and other anomalies varied by cleft type; types 2b/3b and 4 were most frequently associated with other anomalies. The measure of agreement between the prenatal and postnatal findings showed a Kappa value of 0.63 (95% confidence intervals: 0.52-0.75), demonstrating the accuracy of this new classification system. A new prenatal oral cleft classification system is presented. This system appears to be accurate, and it shows the variation in the risk of associated anomalies for each cleft type. We expect that ultrasonographers will be able to use the new classification in daily practice. © 2015 John Wiley & Sons, Ltd.
Tavakolinejad, Sima; Ebrahimzadeh Bidskan, Alireza; Ashraf, Hami; Hamidi Alamdari, Daryoush
Context: Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results. Evidence Acquisition: PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate + stem cells', 'cleft palate + plasma rich platelet', 'cleft palate + scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique. Results: We reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience. Conclusions: Tissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field. PMID:25593724
Klein, Marsha Dunn
This pamphlet on feeding techniques for children who have cleft lip and palate emphasizes the role of the parent as part of a team involving many specialists. The pamphlet begins with explanations of complete and incomplete separations of the lip, unilateral and bilateral cleft lips, corrective surgical procedures, etc. The importance of weight…
Singh, Subodh Kumar
Though India has an estimated population of one million untreated cleft patients, facilities for its treatment have been limited and are not evenly distributed across the country. Furthermore, a paucity of committed cleft surgeons in fewer hospitals to provide quality surgical treatment to these patients, poverty, illiteracy, superstitions and poor connectivity in some remote regions severely limit the chances of an average cleft lip patient born in India from receiving rational and effective comprehensive treatment for his/her malady. The Smile Train Project with its singular focus on cleft patients started its philanthropic activities in India in the year 2000. It made hospitals and included clefts surgeon equal partners in this programme and helped them treat as many cleft patients as they possibly could. The Project encouraged improvement of the training and infrastructure in various centres across the length and breadth of the region. The Project received an unprecedented success in terms of growth of number of centres, cleft surgeons and quantum of cleft patients reporting for treatment. The G S Memorial Hospital is one such partner hospital. It started innovative outreach programmes and took a holistic view of the needs of these patients and their families. With the support of the Smile Train, it has not only succeeded in providing treatment to more than 14,500 patients in 5 years, but has also devised innovative outreach programmes and seamlessly incorporated salient changes in the hospital system to suit the needs of the target population. PMID:19884676
Estrem, Theresa; Broen, Patricia A.
The study comparing word-initial target phonemes and phoneme production of five toddlers with cleft palate and five normal toddlers found that the cleft palate children tended to target more words with word-initial nasals, approximants, and vowels and fewer words with word-initial stops, fricatives, and affricates than normal children. (Author/DB)
Whitehill, Tara; Chau, Cynthia
Many speakers with repaired cleft palate have reduced intelligibility, but there are limitations with current procedures for assessing intelligibility. The aim of this study was to construct a single-word intelligibility test for speakers with cleft palate. The test used a multiple-choice identification format, and was based on phonetic contrasts…
Ugurlu, Mehmet; Baktir, Ahmet Oguz; Tekin, Ali Ihsan; Tok, Ahmet; Yagmur, Bayram
Echinococcosis is endemic in various regions of Turkey. Cardiac involvement in echinococcosis is rare, and lone cardiac hydatid cysts are even more unusual. Because cardiac hydatid disease can be fatal, even asymptomatic patients are optimally referred for surgical treatment. We present a rare case of a lone, primary, mobile hydatid cyst in the left atrium of a 62-year-old woman. The cyst caused dyspnea from left ventricular inflow obstruction. In addition to reporting the patient's fatal case, we discuss cardiac hydatid cysts in terms of the scant medical literature. PMID:27303247
Dammer, U; Driemel, O; Mohren, W; Giedl, C; Reichert, T E
The so-called "globulomaxillary cyst", described as a fissural cyst, caused by entrapped epithelium between the nasal and maxillary process, is no longer considered for its own entity. Nevertheless, cystic lesions, which correspond to the previous image of globulomaxillary cysts, do still occur in daily practice. This raises the question to which entities pathological processes in this particular region actually belong to. In a retrospective study, 17 cases (12 men and 5 women, 12-59 years old) of primarily diagnosed globulomaxillary cysts are analysed according to clinical, radiological and histological aspects, catamnestic processed and assigned to a new entity. The results are compared with the international literature and draws conclusions on the diagnostic and therapeutic procedure. Seven lateral periodontal cysts, four radicular cysts, two keratocystic odontogenic tumours, one adenomatoid odontogenic tumour, one periapical granuloma, one residual cyst and one undefined jaw cyst were determined. According to the results of our study and the data from the international literature, the entity globulomaxillary cyst is no longer justified.
Knani, L; Gatfaoui, F; Krifa, F; Mahjoub, H; Daldoul, N; Ben Hadj Hamida, F
Dermoid cysts are benign congenital orbital tumors, they are classified as choristomas. Clinical manifestations vary according to location and size. We retrospectively analyzed 43 cases of dermoid cysts surgically treated between July 1998 and March 2009. Mean patient age was 18.64 years. Among patients, 48.83% were male. Preseptal location was most common (41 cases). One of the two cases of intraorbital location required orbitotomy. We observed no complications or recurrence. Dermoid cysts are most often seen in young patients. The mean age of our patients was relatively high. The majority of dermoid cysts are periorbital in location. Superficial orbital dermoid cysts are more frequent, present earlier in life and are more easily identified than deep dermoid cysts. Imaging plays a major role in the management of deep orbital tumors. Complete surgical excision has remained the mainstay of treatment. Dermoid cysts are benign orbital tumors. Superficial dermoid cysts are the most common type. Deeper cysts require a more challenging diagnostic and therapeutic approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Kim, D H; Kim, J S; Nam, E S; Shin, H S
Foregut duplication cyst of the stomach is an extremely rare disease entity. A 35-year-old Korean man presented with epigastric pain. An abdominal cystic mass, measuring 7 x 6 x 5 cm, was found in the lesser curvature of the stomach. The cyst was unilocular with a grey-white, rubbery wall. Microscopically, the cyst wall was lined by pseudostratified ciliated, columnar epithelium and gastric mucosa with a complete lining of smooth muscle bundles. Although the origin of this lesion remains uncertain, this case suggests that the gastric cyst arose from the embryonic foregut and showed differentiation toward respiratory and gastric structures.
Brzeziński, Daniel; Kozak, Józef
Introduction Progress in the development of surgical techniques has led to the growing use of video-assisted thoracoscopic surgery (VATS) techniques in mediastinal cyst treatment. Aim To present our experience of treating mediastinal cysts with the minimally invasive technique. Material and methods Fifty patients with mediastinal cysts were treated from 2001 to 2011. There were 32 women and 18 men. The age of the patients ranged from 17 to 72, the mean age being 42 years. All patients underwent basic preoperative diagnostic tests of the chest: X-ray, computed tomography (CT), bronchoscopy and spirometry; 4 patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and 3 fine needle aspiration biopsy (FNAB) of the described lesions. Results The VATS was performed in each case. Conversion was carried out due to superior mediastinal location in 10 cases and pleural adhesions in 3 cases. The partial resection of a cyst was performed in 3 patients. One patient was treated conservatively due to heart failure. In that patient the transthoracic needle aspiration of a cyst under ultrasound guidance using alcoholisation with 76% ethanol with a good effect was performed twice. Cyst recurrence was observed in 1 case. Conclusions The surgical access depends on the location of a cyst. The VATS resection of a superior mediastinal cyst is not always feasible. Surgery of mediastinal cysts is both diagnostic and curative. PMID:25337163
Stein, Drew; Cantlon, Matthew; Mackay, Brendan; Hoelscher, Christian
Popliteal (Baker) cysts, meniscal cysts, proximal tibiofibular joint cysts, and cruciate ligament ganglion cysts are cystic masses commonly found about the knee. Popliteal cysts form when a bursa swells with synovial fluid, with or without a clear inciting etiology. Presentation ranges from asymptomatic to painful, limited knee motion. Management varies based on symptomatology and etiology. Meniscal cysts form within or adjacent to the menisci. These collections of synovial fluid are thought to develop from translocation of synovial cells or extravasation of synovial fluid into the meniscus through a tear. Joint-line pain and swelling are common symptoms. Management entails partial meniscectomy with cyst decompression or excision. Proximal tibiofibular joint cysts are rare, and their etiology remains unclear. Pain and swelling secondary to local tissue invasion is common, and management consists of surgical excision. Cruciate ligament ganglion cysts have no clear etiology but are associated with mucoid degeneration of the anterior and posterior cruciate ligaments, knee trauma, and synovial translocation into these ligaments. Knee pain and limited range of motion, especially with exercise, are common presenting symptoms. In symptomatic cases, arthroscopic excision is commonly performed.
Low, Samantha; Azim, Maleeha; Wan, Elaine; Hariharan, Vimal
Simple renal cysts are most commonly found in the elderly, male population. The majority of simple renal cysts remain untreated, except on the rare occasion when they become complicated with hemorrhage, infection or rupture. We present the case of a 31-year-old female with a simple renal cyst which was initially treated as acute pyelonephritis. A high clinical suspicion led to the diagnosis of an infected renal cyst which was treated with antibiotic therapy and radiological drainage. There were minimal complications and the patient made an uneventful recovery.
Misra, Satya Ranjan; Gopal, Maragathavalli; Mohanty, Neeta; Rastogi, Varun
A nasoalveolar cyst is a rare, non-odontogenic soft tissue cyst encountered in the anterior maxillary labial sulcus as an asymptomatic soft tissue swelling. Often, patients with these cysts report them to the dental clinic where they are mistaken for odontogenic lesions by the dental surgeon, especially if concomitant dental problems are present. They cannot be detected by routine conventional dental radiography as they are peripheral, lying within the mucosa thereby posing a diagnostic challenge. We document a case of a 47-year-old woman with a nasoalveolar cyst. PMID:25566935
Shetty, Gautam M; Nha, Kyung Wook; Patil, Sachin P; Chae, Dong Ju; Kang, Ki Hoon; Yoon, Jung Ro; Choo, Suk Kyu; Yi, Jeong Woo; Kim, Ji Hoon; Baek, Jong Ryoon
Ganglion cysts of the posterior cruciate ligament (PCL) are uncommon lesions found incidentally on MRI and arthroscopy. Twenty patients (11 males and nine females) with the mean age of 35 years presenting with a variety of knee signs and symptoms were found to have PCL cysts on MRI. Out of these, thirteen patients (65%) had isolated symptomatic PCL cysts and seven patients had associated chondral and meniscal lesions. Eight out of the 20 patients (40%) gave a history of antecedent trauma. On arthroscopy, the majority of the cysts were situated at the midsubstance of the ligament with inter-cruciate distension and no involvement of the substance of the ligament. The content of the cysts varied with the majority having yellowish viscous fluid and three containing serous and bloody fluid. All cysts were successfully treated arthroscopically through standard anterior, posteromedial and posterolateral portals with no signs of recurrence on MRI at a mean followup of 24 months. PCL cysts may clinically mimic meniscal or chondral lesions and preoperatively, MRI is essential for the diagnosis of ganglion cysts arising from the PCL. Ganglion cysts of the PCL can be successfully treated arthroscopically using standard portals.
Seydafkan, Shabnam; Shibata, David; Sanchez, Julian; Tran, Nam D; Leon, Marino; Coppola, Domenico
Gastrointestinal (GI) tract duplication cysts or enteric duplication cysts are rare congenital malformations sometimes found on the mesenteric aspect of segments of the alimentary tract. Enteric duplication cysts are lined by normal GI epithelium and may be classified as foregut, mid-gut, and hindgut cysts. Except in very rare cases of retroperitoneal enteric duplication cysts, these cysts communicate with the GI tract and share a common blood supply. Concurrent congenital malformations are not uncommon and malignant transformation within enteric duplication cysts has also been reported. We describe a case of a noncommunicating enteric duplication cyst in a 52-year-old woman. The patient presented with a presacral cystic mass requiring frequent drainage procedures that was primarily believed to be of neural origin. Upon resection, the lesion contained heterotopic tissue, including ciliated bronchial epithelium, squamous and transitional epithelia, and pancreatic and gastric tissue. Focal, low-grade intestinal adenoma was present, but malignancy was not detected in this case. To our knowledge, this is the sixth reported case of a noncommunicating enteric duplication cyst in the English medical literature.
Hastings, Newlin; Norris, William J.
In a 20-year period at the Los Angeles Children's Hospital, 46 infants and children have had operation for cysts within the abdomen. The age range of patients was from newborn to 13 years. Most of them were under four years old. There were four general groups of these cysts. (1) About one-half were cysts of the ovary, some of them serous and some dermoid. These cysts are attached by a stalk that often twists, causing gangrene or rupture with acute symptoms simulating appendicitis. (2) Next in frequency were cysts arising in the mesentery of the intestine. They usually caused little trouble until by their size (up to a 2-quart capacity) they created pressure and obstruction in the intestine. (3) Enteric cysts were found in four patients. (4) Cysts of the pancreas were present in three of the children. X-ray examination was helpful in diagnosis. Usually the type of cyst was not determined until operation was done. Transection of the intestinal tract sometimes was necessary for removal of the cyst. Surgical correction was satisfactory in 44 of the 46 cases. PMID:13182628
Khouri, Joseph S; McCheyne, Melisande J; Morrison, Clinton S
Many societies and organizations are using social media to reach their target audience. The extent to which parents of patients with craniofacial anomalies use social media has yet to be determined. The goal of this study is to characterize and describe the use of social media by the parents of children with cleft lip and palate as it pertains to the care of their child. Parents or guardian of all patients presenting for initial consultation regarding a child's congenital cleft anomaly were contacted by phone or mail to complete a survey regarding their use of social media vis-à-vis their child's cleft anomaly. Participants were asked to answer a 19-question survey. Thirty-two families were contacted and 25 surveys were completed. Ninety-two percent of respondents used social media to learn about their child's diagnosis. Facebook (76%) and blogs (24%) were the most commonly accessed social media outlets, followed by Instagram (8%). Education about the diagnosis and treatment of cleft pathology (87%) was the most common reason for accessing social media, followed by companionship and support (56%), and advice about perioperative care (52%). Almost half (43%) of parents used social media to obtain information on their caregiver and treatment team, and 26% of parents used information gained on social media to guide their decision on where to seek care. Social media is a readily available resource, one that will certainly shape the experiences of our patients and families for years to come.
Xiao, Wen-Lin; Zhang, Dai-Zun; Xu, Yao-Xiang
Little information is available concerning the prevalence of caries among patients with oral clefts in Eastern China. Consecutive patients aged 6-18 with oral clefts were recruited. Patients were stratified into 2 groups according to their ages, namely Group I with aged 6-12 and Group II with aged 13-18. For each age group, the children were further divided into three subgroups according to the types of oral clefts they had: cleft lip/cleft lip and alveolus (CL), cleft palate only (CP), and cleft lip and palate (CLP). Dental caries were examined by using the decayed, missing, and filled index for primary teeth (dmft) and Decay, Missing and Filled index for Permanent teeth (DMFT) according to criteria of the World Health Organization. 268 eligible patients with oral clefts were included in the study. The mean DMFT for Group I was 1.77 (SD2.58) while that for Group II was 6.96 (SD4.35). The mean DMFT was statistically significant different between the age group I and age group II (t=12.21, P<0.05). In Group I, the dmft scores was 4.68 (SD3.67) for CL group, while that for the CP group was 7.36 (SD3.93), and that for the CLP group was 5.72 (SD 3.87). The mean dmft was no statistically significant different among cleft types (F=3.13, P>0.05). Also in Group I, the mean DMFT was 1.56 (SD2.18) for CL group, while that for the CP group was 1.24 (SD 1.81) and that for the CLP group was 2.08 (SD2.96). There were no statistically significant different in mean DMFT among different cleft types (F=1.09, P>0.05). In Group II, the mean DMFT was 6.06 (SD3.97) for CL group while that for the CP group was 7.71 (SD 4.94) and that for the CLP group was 7.05 (SD4.32). No significant difference was shown in the mean DMFT among different cleft groups (CL, CP, and CLP) (F=0.55, P>0.05). During assess the prevalence of dental caries among Eastern Chinese with oral clefts; the study confirmed that the prevalence of caries was increased with increasing age for oral clefts patients. It was
de Ladeira, Pedro Ribeiro Soares; Alonso, Nivaldo
Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice. PMID:23213503
Cassini, Maria Antonietta; Cerroni, Loredana; Ferlosio, Amedeo; Orlandi, Augusto; Pilloni, Andrea
Stillman's cleft is a mucogingival triangular-shaped defect on the buccal surface of a root with unknown etiology and pathogenesis. The aim of this study is to examine the Stillman's cleft obtained from excision during root coverage surgical procedures at an histopathological level. Harvesting of cleft was obtained from two periodontally healthy patients with a scalpel and a bevel incision and then placed in a test tube with buffered solution to be processed for light microscopy. Microscopic analysis has shown that Stillman's cleft presented a lichenoid hand-like inflammatory infiltration, while in the periodontal patient an inflammatory fibrous hyperplasia was identified. Stillman's cleft remains to be investigated as for the possible causes of such lesion of the gingival margin, although an inflammatory response seems to be evident and active from a strictly histopathological standpoint.
Cassini, Maria Antonietta; Cerroni, Loredana; Ferlosio, Amedeo; Orlandi, Augusto; Pilloni, Andrea
Summary Aim of the study Stillman’s cleft is a mucogingival triangular-shaped defect on the buccal surface of a root with unknown etiology and pathogenesis. The aim of this study is to examine the Stillman’s cleft obtained from excision during root coverage surgical procedures at an histopathological level. Materials and method Harvesting of cleft was obtained from two periodontally healthy patients with a scalpel and a bevel incision and then placed in a test tube with buffered solution to be processed for light microscopy. Results Microscopic analysis has shown that Stillman’s cleft presented a lichenoid hand-like inflammatory infiltration, while in the periodontal patient an inflammatory fibrous hyperplasia was identified. Conclusion Stillman’s cleft remains to be investigated as for the possible causes of such lesion of the gingival margin, although an inflammatory response seems to be evident and active from a strictly histopathological standpoint. PMID:26941897
Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate. PMID:26273624
Pape, Hans-Dieter; Koch, Heribert; Koller, Michael
Background: Cleft lip and palate surgery abroad is devoid of global consensus regarding standards of therapy, follow-up, and outcome. Cleft surgery in Nepal during a 10-year sustained program provided the opportunity to inform on the need for such standards. Methods: Medical records were evaluated from the cleft clinic at Sushma Koirala Memorial Hospital, Sankhu, Kathmandu, Nepal, from 1997 to 2007. Four groups were identified for analysis: total cohort, total surgical cohort (TSC), primary program patients (PPP; patients had not been operated on before), and nonprimary program patients (non-PPP; patients operated on elsewhere before). Patient demographics, diagnostic, primary and secondary surgery (corrective surgery), and follow-up were evaluated. Results: One thousand forty-five patients were eligible for surgery. Three hundred twenty-three of 1,045 patients (30.9%) did not seek treatment, although scheduled for surgery. One thousand two hundred one procedures were performed in 722 patients [TSC; 845 PPP (70.4%); 356 non-PPP (29.64%)]. Corrective procedures were performed in 257 of 1,201 [3.5% (30 of 845 procedures in 509 patients) PPP vs 63.7% (227 of 356 procedures in 213 patients) non-PPP]. One hundred six lips were completely reoperated on (1 PPP vs 105 non-PPP), and 42 palates underwent a total revision (5 PPP vs 37 non-PPP). The surgical outcome of the TSC group in terms of complication rate was similar to the one in developed countries. Conclusions: The high rate of corrective surgery reveals the need for global regulatory mechanisms and the need for nongovernmental organizations to introduce strategies for delivering sustained cleft care until achieving full rehabilitation. The World Health Organization should establish standards for cleft care delivered in less developed countries. PMID:27579235