Ethmoid Plate Research Articles

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall.

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

Use of Perpendicular Plate of Ethmoid Split Technique in Rhinoplasty and Septoplasty.

In recent years, the perpendicular plate of ethmoid (PPE) has become a prominent choice for bone-grafting materials. This study introduces the PPE split technique for efficient removal of the bony septum or the harvesting of partial PPE for septal batten grafts in rhinoplasty and septoplasty, particularly suited for cases with thick PPE. Herein, this technique was employed to minimize septal defects and prevent complications while achieving harvested bony grafts of the desired effective thickness. In this retrospective study, 36 patients underwent surgery using the PPE split technique (22 septoplasties and 14 rhinoplasties). The procedure involved detaching the PPE from the septal cartilage and performing a vertical plane osteotomy with a number 10 scalpel blade to remove bony spurs or prepare batten grafts. Paranasal sinus CT revealed that the average anteroinferior PPE thickness was 3.46 mm. This technique was used for both bony batten graft harvesting (26 cases) and bony spur removal, and septum reshaping (10 cases). Successful PPE harvesting was achieved in all cases except for three, which experienced graft breakage. This study demonstrates the viability and effectiveness of the PPE split technique as a supplementary maneuver in septoplasty and rhinoplasty procedures. Its diverse applications include reshaping, correcting deviated septum, harvesting bony batten grafts, and providing support for an aesthetically pleasing nasal profile.

Double Reinforcing Strategy with Perpendicular Plate of Ethmoid in Asian Secondary Unilateral Cleft Rhinoplasty: A Finite Element Analysis.

Deviation and asymmetry relapse after secondary unilateral cleft rhinoplasty with septal extension graft is a common yet serious problem especially among Asian patients. Therefore, finding an effective approach to reduce deformity relapse remains a great challenge to plastic surgeons. In this study, authors established finite element models to simulate different nasal cartilage-corrected options and different reinforcing strategies in secondary unilateral cleft rhinoplasty. A load of 0.01N was given to the nasal tip to simulate the soft tissue pressure, while two loads of 0.5N were separately given to the anterior and posterior part of the septal extension graft to simulate the rhinoplasty condition. Maximum deformations were evaluated to make stability judgments. The maximum deformation of different cartilage correction models in ascending order was: UCL deformity with septum correction, normal nasal cartilage, UCL nasal deformity, and UCL nasal deformity with lower lateral cartilage correction. When applied L-strut reinforcement graft was harvested from the perpendicular plate of the ethmoid bone, the maximum deformation of the models decreased significantly, and strong fixation of the septum could further enhance this decreasing effect. Correcting the septum and lower lateral cartilage together could improve the structural stability and symmetry in secondary unilateral cleft rhinoplasty. To keep the corrected septum stable and thus reduce deformity relapse, reinforcing the L-strut with perpendicular plate of ethmoid graft while strongly anchoring the septal cartilage to the anterior nasal spine was proved to be effective in both finite element analysis and clinical observation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

P53 inhibitor or antioxidants reduce the severity of ethmoid plate deformities in zebrafish Type 3 Treacher Collins syndrome model

Treacher Collins syndrome-3 (TCS-3) is a rare congenital craniofacial disorder attributed to variants in the RNA pol I subunit C (POLR1C). The pathogenesis of TCS-3 linked to polr1c involves the activation of apoptosis-dependent p53 pathways within neural crest cells (NCCs). This occurs due to disruptions in ribosome biogenesis, and the restoration of polr1c expression in early embryogenesis effectively rescues the observed craniofacial phenotype in polr1c-deficient zebrafish. Clinical variability in TCS patients suggests interactions between genes and factors like oxidative stress. Elevated production of reactive oxygen species (ROS) in epithelial cells may worsen phenotypic outcomes in TCS individuals. Our study confirmed excessive ROS production in facial regions, inducing apoptosis and altering p53 pathways. Deregulated cell-cycle and epithelial-to-mesenchymal transition (EMT) genes were also detected in the TCS-3 model. Utilizing p53 inhibitor (Pifithrin-α; PFT-α) or antioxidants (Glutathione; GSH and N-Acetyl-L-cysteine; NAC) effectively corrected migrated NCC distribution in the pharyngeal arch (PA), suppressed oxidative stress, prevented cell death, and modulated EMT inducers. Crucially, inhibiting p53 activation or applying antioxidants within a specific time window, notably within 30 h post-fertilization (hpf), successfully reversed phenotypic effects induced by polr1c MO.

METTL3-dependent m6A modification of PSEN1 mRNA regulates craniofacial development through the Wnt/β-catenin signaling pathway

Craniofacial malformations, often associated with syndromes, are prevalent birth defects. Emerging evidence underscores the importance of m6A modifications in various bioprocesses such as stem cell differentiation, tissue development, and tumorigenesis. Here, in vivo, experiments with zebrafish models revealed that mettl3-knockdown embryos at 144 h postfertilization exhibited aberrant craniofacial features, including altered mouth opening, jaw dimensions, ethmoid plate, tooth formation and hypoactive behavior. Similarly, low METTL3 expression inhibited the proliferation and migration of BMSCs, HEPM cells, and DPSCs. Loss of METTL3 led to reduced mRNA m6A methylation and PSEN1 expression, impacting craniofacial phenotypes. Co-injection of mettl3 or psen1 mRNA rescued the level of Sox10 fusion protein, promoted voluntary movement, and mitigated abnormal craniofacial phenotypes induced by mettl3 knockdown in zebrafish. Mechanistically, YTHDF1 enhanced the mRNA stability of m6A-modified PSEN1, while decreased METTL3-mediated m6A methylation hindered β-catenin binding to PSEN1, suppressing Wnt/β-catenin signaling. Pharmacological activation of the Wnt/β-catenin pathway partially alleviated the phenotypes of mettl3 morphant and reversed the decreases in cell proliferation and migration induced by METTL3 silencing. This study elucidates the pivotal role of METTL3 in craniofacial development via the METTL3/YTHDF1/PSEN1/β-catenin signaling axis.

Osteopathic Manipulative Treatment to Treat Patients with Long-Haul COVID Loss of Smell and Taste: A Report of Four Cases

Abstract Four cases of patients with Long COVID symptoms of loss of the sense of smell and sense of taste are presented. They differ from the findings in the published case record of anosmia and loss of taste in Magoun. Osteopathic examination revealed flexion and extension of the occiput. No flexion or extension motion of the sphenoid was appreciated. A novel application of the underlying concepts of Osteopathic Cranial Manipulative Medicine is described. This approach resulted in a rapid resolution of the symptoms of loss of the senses of smell and taste, which have persisted for more than a year. An hypothesis for a possible mechanism of the pathophysiology is advanced. The olfactory nerve (CN I) lies on the cribriform plate of the ethmoid bone. When the inflamed sphenoid flexes, becoming stuck down forward on the cribriform plate of an inflamed ethmoid. This may have resulted in impingement of CN I, which then resulted further in anosmia (loss of smell) and concomitant loss of taste.

Reconstruction of Medial Orbital Wall Using Autologous Perpendicular Plate of Ethmoid.

The aim of this study is to investigate the feasibility of perpendicular plate of ethmoid as material for the reconstruction of medial orbital wall. The main outcome measurement was preoperative and postoperative orbital volume. The authors performed a study including 17 patients who have isolated medial orbital wall fracture (blow-out fracture). All the patients were fixed the defect using autologous perpendicular plate of ethmoid under endonasal approach. The authors compared the preoperative and postoperative orbital volume difference (unaffected orbit, affected orbit) of all the patients, and observed the improvement of diplopia or ocular motility disorders after operation. All 17 medial orbital wall reconstruction surgeries were successful with no severe postoperative ophthalmic complications. Statistically significant differences were found between the preoperative and postoperative orbital tissue volumes for the affected orbit. There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction. And postoperative computed tomography showed the implant is in place and there is no medial rectus incarceration. Autologous perpendicular plate of ethmoid proved to be safe and effective in the reconstruction of medial orbital wall under endonasal approach with cost-effectivence, low complication rate, high biocompatibility, and minimally invasion.

Prickle planar cell polarity protein 1 involved in the pathogenesis of skeletal class Ⅲ malocclusion

Objective: To explore the mechanisms of prickle planar cell polarity protein 1 (PRICKLE1) involved in the occurrence of skeletal Class Ⅲ malocclusion. Methods: After extracting the genomic DNA of all family members of the skeletal Class Ⅲ malocclusion pedigree with maxillary hypoplasia collected in the Department of Orthodontics at the Affiliated Stomatological Hospital of Nanjing Medical University in October 2021, whole exome sequencing and Sanger sequencing were performed to screen pathogenic genes/mutation sites and validate the mutations. Jaw tissue was collected during the operation of orthognathic patients who were treated in the Department of Oral and Maxillofacial Surgery at the same hospital from October 2021 to December 2022. Following the extraction of human jaw bone marrow mesenchymal stem cells and transfection with overexpressing lentivirus (lentiviruses overexpressing the gene of interest served as the wild group, lentiviruses overexpressing mutation site served as the mutant group) and knockdown lentivirus (divided into knockdown group 1 and 2, with transfection interference negative lentiviruses as the control group). Various assays including real-time fluorescence quantitative PCR (RT-qPCR), Western blotting, proliferation and Transwell assays, alkaline phosphatase staining and alizarin red staining were performed. Construction of zebrafish animal model, antisense morpholino oligonucleotide (MO) were injected to knock down the expression of prickle1a and prickle1b in zebrafish (co-knocking group), and the control group was injected with standardized MO as a reference. Transcriptome sequencing, enrichment analysis and co-expression analysis were performed on the zebrafish craniofacial tissues of the two groups. Results: Two patients of this family carried this mutation PRICKLE1 c.113C>T. The transfection experiments showed that compared with the wild group (relative expression of PRICKLE1 was 21.97±0.60), the relative expression of mutant group (5.05±0.05) was significantly reduced (P<0.05), and cell proliferation and migration ability significantly enhanced (P<0.05), and osteogenic differentiation ability was significantly reduced (P<0.05). Compared with the control group, the proliferation and migration ability of cells in the two knockdown groups were significantly enhanced (P<0.05), and the osteogenic differentiation ability was significantly reduced (P<0.05). Zebrafish model experiments showed the width of the ethmoid plate was significantly reduced in the co-knocking group (282.50±61.77, t=5.29, P<0.001) compared with the control group (338.80±24.92). Transcriptome data and enrichment analysis showed that the differentially expressed genes were significantly enriched in the mitogen-activated protein kinase (MAPK) signaling pathway after the simultaneous knockdown of prickle1a and prickle1b in zebrafish. Conclusions: PRICKLE1 c.113C>T mutation might suppress the osteoblastic differentiation ability of jaw bone marrow mesenchymal stem cells by downregulating the MAPK signaling pathway, thereby involving the development of skeletal Class Ⅲ malocclusion.

Comparison of the transverse cranial base dimension in different craniofacial skeletal relationships: A cone-beam computed tomography study

Background/purposeIn comparing the cranial base's size, most cephalometric studies focused on the length and angle in the anteroposterior direction. However, investigating the anterior, middle, and posterior cranial base's transverse dimensions is challenging. This study aimed to investigate the transverse dimensions of the cranial base in different craniofacial skeletal patterns and sexes using cone-beam computed tomography (CBCT). Materials and methodsA total of 210 adults (105 males and 105 females), including three different skeletal relationships, were included in the study. The cranial base dimensions were measured on a three-dimensional image structure rendered by CBCT. Statistical methods included the Kappa statistic for analysis of consistency and reproducibility and the independent t-test for differences in cranial base dimensions between sexes. A general linear model (GLM) was used to compare the transverse size of the cranial base among skeletal Class I, II, and III groups. The Pearson correlation coefficient explored the correlation among the cranial base dimensions. ResultsThe cranial base dimensions did not differ significantly between skeletal Class I, II, and III. The more prominent cranial base size was found in males than females, except for the crista galli length (CGL) and cribriform ethmoid plate width (CEPW). The cranial base dimensions did not differ significantly between different skeletal relationships. Most dimensions have significant correlations in the middle and the posterior cranial base. ConclusionThe cranial base's transverse dimensions in Taiwanese adults show no significant differences between craniofacial skeletal relationships. In the middle and posterior cranial base, transverse measurements reveal significant sexual dimorphism.

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients.

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly (P<0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) (P<0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% (P<0.01) and 27.6% (P<0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased (P<0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased (P<0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction (P<0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.

Use of nasal septal bone to straighten septal L-Strut in correction of east Asian short nose: A retrospective study.

The perpendicular plate of ethmoid (PPE) was used to correct short noses in rhinoplasty in Asians, but the safe harvest of the plate and the assessment of its clinical application has been perplexing to plastic surgeons. To explore how to safely cut the perpendicular plate of ethmoid bone and evaluate its application effect. A finite element model was established to guide the clinical operation. A total of 30 patients with short noses were selected. Among them, 15 patients used autologous septal cartilage to lengthen the nasal tip, and 15 patients used the PPE to strengthen the L-shape nasal septum. The differences in the esthetic parameters of the nose, complications, and patients' satisfaction were compared between the two groups. Significant differences were noted in the nasal dorsal length (p=0.001), Goode's ratio (p=0.001), and nasofrontal angle (p=0.003) after rhinoplasty, and no significant differences were noted in any of the esthetic parameters between the two groups. The symptoms of nasal obstruction in the experimental group were significantly lighter than those in the control group (p=0.04). There was no statistically significant difference in the doctors' assessment of outcomes between the two groups (p=0.48). The safest region to harvest the PPE is in the middle and lower third. Rhinoplasty improves the esthetics of the patient's nose. The PPE used to strengthen the L-shape nasal septum structure has a smaller probability of nasal septal deviation with the time in Asian short noses.

Spatiotemporal Profile of Skeletal Development in Bonylip Barb, Osteochilus vittatus (Valenciennes, 1842)

Skeletal development is essential in supporting aquaculture success, as failure and deformities reduce fish viability and growth. Herein, the cartilage and bone formation in the larva and juvenile of the bonylip barb, Osteochilus vittatus (Valenciennes, 1842), is described in detail for the first time. Mature fish were injected with ovaprim at 0.5 mL.kg-1 body weight, followed by artificial spawning. After fertilisation, the embryos were reared in a glass container at 28 ± 1 °C. The first hatchling was observed at 26 h and 15 min post-fertilisation (pf), and the last was observed at 48 hpf. The cartilage and bone development were observed from 1 to 30 days post-hatching (dph) by alcian blue and alizarin red S staining. Freshly hatched fish larvae had not undergone either chondrification or ossification. The cartilage was observed at 1 dph, marked with Meckel’s cartilage, ethmoid plate, and pectoral fin, as the pre-larva had a standard length (SL) of 5 mm. At 5 dph (SL of 5.6 ± 0.55 mm), 3 to 4 pairs of basidorsal and basiventral were observed. The cartilaginous development ended at 26 dph as the SL reached 14.3 ± 0.57 mm. The ossification started at 20 dph (SL of 9.24 ± 0.68 mm) and was marked with opercle and cleithrum. At 26 dph, as the post-larvae length 14.3 ± 0.57 mm, dentary, pterotic, and parasphenoid were ossified. Juvenile fish at 30 dph (SL of 21.2 ± 3.9 mm) showed completed ossification processes in the cranium and vertebrae.

Inhibition of the 3-hydroxy-3-methyl-glutaryl-CoA reductase diminishes the survival and size of chondrocytes during orofacial morphogenesis in zebrafish.

The 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCR) is the enzyme controlling the rate-limiting step in the synthesis of cholesterol, sterols, and isoprenoids in the mevalonate biosynthetic pathway. Impaired function of HMGCR in zebrafish produces craniofacial malformations and orofacial cleft, mainly affecting the post-migratory neural crest cells with little earlier effect. Here we investigate morphogenetic and cellular mechanisms underlying the generation of these malformations. The morphology of chondrocytes in the lower jaw and the proliferation/apoptosis in the ethmoid plate were analysed in hmgcr1b mutants and in embryos treated with atorvastatin. In the ceratohyal of treated embryos, we measured the number and dimensions of chondrocytes. In the ethmoid plate, we performed proliferation and apoptosis assays to quantify the number of cells undergoing each process in both hmgcr1b mutants and pharmacologically treated embryos. All embryos were imaged using confocal microscopy and processed to obtain maximum intensity z-projection. The shortening of the ceratohyal is produced by a moderate reduction in the number of cells combined with isometric shrinkage of the chondrocytes. At the same time, the shortening of the ethmoid plate is due to a combination of a slightly diminished proliferation with massive abnormal apoptosis at the proliferation front. HMGCR function is necessary for the normal survival and morphology of chondrocytes during condensation and chondrogenesis in the developing palate and jaw. Further studies are required to establish the pathways through which HMGCR acts on apoptosis, proliferation, and cell size during normal craniofacial development.

The ethmoid bone is the ideal graft to strengthen nasal septum L-strut among different grafts: An evaluation based on finite element analysis.

In the rhinoplasty of Asian short nose deformity, the surgeon cuts a portion of septal cartilage and retains the nasal septum L-strut, but a deviated nasal septum is formed after the surgery under forces of soft tissue contracture. Although various autologous grafts are used to reinforce the L-strut, there is a lack of objective "mechanical theory" to support the clinical findings in other studies at the present time. A simplified and geometrical finite element model of L-strut reinforced with clinically common materials, including auricular cartilage, nasal septal cartilage, and perpendicular plate of ethmoid, was established. Simulating the mechanical environment of nasal tip in reality, when the force was loaded, the von Mises stress and directional deformation of the L-strut were observed under different widths. Kruskal-Wallis test was used to examine the significance of intergroup differences of L-strut, and P<0.05 indicated statistical significance. All autologous grafts decreased the maximum directional deformation of L-strut, and the variance of nasal tip displacement was reduced; the perpendicular plate of ethmoid showed a distinct effect. The increasing width of the L-strut reduced the maximum displacement of the nasal tip, but the influence of using grafts as a reinforcement to the L-strut was much greater than the residual width (p=0.003). The graft reinforcement significantly increased the stability of the L-strut, which enhanced the resistance to deformation in the long-term action of tension, and the effect of the perpendicular plate of ethmoid to reinforce was significantly better than that of auricular and nasal septal cartilage.

Micro-CT analysis reveals the changes in bone mineral density in zebrafish craniofacial skeleton with age.

Bone has multiple functions in animals, such as supporting the body for mobility. The zebrafish skeleton is composed of craniofacial and axial skeletons. It shares a physiological curvature and consists of a similar number of vertebrae as humans. Bone degeneration and malformations have been widely studied in zebrafish as human disease models. High-resolution imaging and different bone properties such as density and volume can be obtained using micro-computed tomography (micro-CT). This study aimed to understand the possible changes in the structure and bone mineral density (BMD) of the vertebrae and craniofacial skeleton with age (4, 12 and 24months post fertilisation [mpf]) in zebrafish. Our data showed that the BMD in the vertebrae and specific craniofacial skeleton (mandibular arch, ceratohyal and ethmoid plate) of 12 and 24 mpf fish were higher than that of the 4 mpf fish. In addition, we found the age-dependent increase in BMD was not ubiquitously observed in facial bones, and such differences were not correlated with bone type. In summary, such additional information on the craniofacial skeleton could help in understanding bone development throughout the lifespan of zebrafish.

Skeletal Class III Malocclusion Is Associated with ADAMTS2 Variants and Reduced Expression in a Familial Case.

Skeletal Class III malocclusion with maxillary deficiency is a severe maxillofacial disease with unclear pathogenic mechanisms. We recruited a Han Chinese family who was clinically diagnosed with skeletal Class III malocclusion and maxillary deficiency. Using whole exome sequencing, a missense variant in ADAMTS2 (NM_014244: c.3506G>T: p.G1169V) was identified and predicted as deleterious by in silico tools. We also found ADAMTS2 variants associated with deficient maxillary development in a cohort. ADAMTS2 expression in HEK293 cells showed significant decrease due to the variant, which was also consistent in dental pulp stem cells from the proband and a healthy control. In the adamts2-knockdown zebrafish model, the length and width of the ethmoid plate, as well as the length of the palatoquadrate became significantly shorter than the control group (p < 0.001), while there was no significant difference in the length and width of the mandible. The expression of Sox3, which was required in early embryonic craniofacial development, was significantly downregulated in the adamts2-knockdown zebrafish embryos. Bioinformatic and cellular studies showed that the decreased expression of ADAMTS2 may inhibit downstream ErbB signaling pathway transduction and restrain subsequent osteogenesis in human adult mesenchymal stromal cells. Collectively, these data showed that ADAMTS2 (c.3506G>T: p.G1169V) may confer susceptibility to risk of skeletal Class III malocclusion with maxillary deficiency.

Soybean Meal-Dependent Acute Intestinal Inflammation Delays Osteogenesis in Zebrafish Larvae.

Foods are known to be modulators of inflammation and skeletal development. The intestine plays an essential role in the regulation of bone health mainly through the regulation of the absorption of vitamin D and calcium; in fact, inflammatory bowel diseases are often related to bone health issues such as low bone mineral density, high fracture risk, osteoporosis and osteopenia. Considering the complexity of the pathways involved, the use of a simple animal model can be highly useful to better elucidate the pathogenic mechanisms. Soybean flour with a high saponin content has been used in many studies to induce intestinal inflammation in zebrafish larvae. Using a 50% soybean meal (SBM), we analyzed the effects of this soy-induced inflammatory bowel disease on zebrafish larval osteogenesis. Soybean meal induces intestinal functional alterations and an inflammatory state, highlighted by neutral red staining, without altering the general development of the larvae. Our data show that the chondrogenesis as well as endochondral ossification of the head of zebrafish larvae are not affected by an SBM-diet, whereas intramembranous ossification was delayed both in the head, where the length of the ethmoid plate reduced by 17%, and in the trunk with a delayed vertebral mineralization of 47% of SBM larvae. These data highlight that diet-dependent bowel inflammation can differently modulate the different mechanisms of bone development in different zones of the skeleton of zebrafish larvae.

PARD3 gene variation as candidate cause of nonsyndromic cleft palate only.

Nonsyndromic cleft palate only (NSCP) is a common congenital malformation worldwide. In this study, we report a three‐generation pedigree with NSCP following the autosomal‐dominant pattern. Whole‐exome sequencing and Sanger sequencing revealed that only the frameshift variant c.1012dupG [p. E338Gfs*26] in PARD3 cosegregated with the disease. In zebrafish embryos, ethmoid plate patterning defects were observed with PARD3 ortholog disruption or expression of patient‐derived N‐terminal truncating PARD3 (c.1012dupG), which implicated PARD3 in ethmoid plate morphogenesis. PARD3 plays vital roles in determining cellular polarity. Compared with the apical distribution of wild‐type PARD3, PARD3‐p. E338Gfs*26 mainly localized to the basal membrane in 3D‐cultured MCF‐10A epithelial cells. The interaction between PARD3‐p. E338Gfs*26 and endogenous PARD3 was identified by LC–MS/MS and validated by co‐IP. Immunofluorescence analysis showed that PARD3‐p. E338Gfs*26 substantially altered the localization of endogenous PARD3 to the basement membrane in 3D‐cultured MCF‐10A cells. Furthermore, seven variants, including one nonsense variant and six missense variants, were identified in the coding region of PARD3 in sporadic cases with NSCP. Subsequent analysis showed that PARD3‐p. R133*, like the insertion variant of c.1012dupG, also changed the localization of endogenous full‐length PARD3 and that its expression induced abnormal ethmoid plate morphogenesis in zebrafish. Based on these data, we reveal PARD3 gene variation as a novel candidate cause of nonsyndromic cleft palate only.

Measurement of nasal septum area in 128 Chinese patients with nasal septum deviation

Objective:Establish the anatomical parameters of the nasal septum and the area of each component in patients with nasal septum deviation, for the sake of guiding the scope of surgical resection for correction of nasal septum deviation. Methods:This is a retrospective study of 128 cases of sinus computer tomography images of patients with nasal septum deviation, marked 9 nasal septal anatomical locations, measured the area of the nasal septum and its components, and analyzed the trend of the percentage of the area of the nasal septum cartilage in the total area of the nasal septum with age. Results:The total area of the nasal septum in the 128 patients with nasal septum deviation is: （2951.96±305.91） mm², the area of nasal septal cartilage: （961.89±229.64） mm², the area of the vertical ethmoid plate: （1123.96±214.17） mm², the area of the vomerine: （652.77±108.09） mm². The area of male septum is larger than that of female. As age increases, the nasal septal cartilage gradually decreases, and the percentage of the nasal septal cartilage area in the total area of the nasal septum gradually decreases. Conclusion:Elderly people who undergo nasal septum correction should be carefully considered to grasp the scope of resection, and the influence of gender on the area of nasal septum should also be paid attention.

EP.FRI.828 Accidental Placement of Nasogastric Tube into the brain

Abstract The nasogastric tube (NGT) plays a very vital role in the early resuscitation of head injury patients for various reasons. Though considered a simple procedure, it can be associated with multiple dreadful complications. Our patient was a 44-year-old male, referred from a peripheral health center for further management of severe head and faciomaxillary injuries following a motor vehicular accident. On arrival at the hospital, the endotracheal tube and NGT were in situ. A computed tomography scan of the brain revealed the NGT piercing through the cribriform plate of ethmoid and coiling into the cranial cavity with pneumocephalus. The NGT was retrieved under C-arm guidance and his injuries were managed respectively. The patient was discharged after prolong hospitalization with an acceptable outcome. With this case report, we want to remind emergency health care providers to avoid this catastrophic complication of NGT insertion in a faciomaxillary trauma patient by doing it transorally. We report a novel method of safely removing NGT which has not been reported in the past.