Lateral Lip Research Articles

Apex of Triceps Aponeurosis: A Reliable Landmark to Localize the Radial Nerve.

The patient is anesthetized and placed in the lateral decubitus position with the elbow of the operative limb hanging freely over a bolster. A posterior midline incision centered over the fracture is made on the posterior aspect of the arm. The superficial and deep fascia are incised. The triceps aponeurosis is formed by the convergence and fusion of the lateral and long heads of the triceps. The most proximal confluence can be termed the "apex of the triceps aponeurosis." The radial nerve can be isolated approximately 2.5 cm proximal to the apex by developing an intramuscular plane. The remainder of the intramuscular dissection for plate fixation can then be performed safely without risking injury to the radial nerve. Numerous studies have established the relationship of the radial nerve to a fixed osseous point such as the medial epicondyle, lateral epicondyle, and angle of the acromion4-9. Additionally, the wide range of measurements of these anatomic relationships, as reported in various studies, makes it difficult for the operating surgeon to locate the radial nerve, especially in the setting of a fractured humeral shaft. For example, the reported distance of the radial nerve from the lateral epicondyle ranges from 6 to 16 cm and the distance from the angle of the acromion ranges from 10 to 19 cm. Even identification of the superficial branch of the radial nerve has been shown to help intraoperative localization of the radial nerve10. However, these studies have been conducted on cadavers with intact humeri, and their accuracy has not been demonstrated on the patients in the clinical milieu of trauma. The described soft-tissue landmark, which lies approximately 2.5 cm proximal to the apex of the triceps aponeurosis, reliably locates the radial nerve intraoperatively11. It is based on the anatomical fact that the origins of the lateral head (oblique ridge corresponding to the lateral lip of the spiral groove) and long head (infraglenoid tubercle of the scapula) are well above fractures of the middle and distal thirds of the humerus. Hence, the relationship of the radial nerve to the soft point represented by the apex of the aponeurosis is not likely to be disturbed in the setting of fractures distal to it, in sharp contrast with previously described osseous landmarks. Employing this anatomical understanding resulted in early localization of the radial nerve (within 6 ± 1.5 minutes of skin incision) and less blood loss (188 ± 13 mL)11. Patients are likely to retain their ability to perform active dorsiflexion of the wrist and fingers and have sensory preservation in the distribution of autonomous zone of the radial nerve after the procedure. The relationship of the radial nerve to the soft point represented by the apex of the aponeurosis is not likely to be disturbed in the setting of typical fractures distal to it; however, this may differ in cases of severely displaced or comminuted fractures, and the surgeon should be aware of this fact.The surgeon should remain careful to protect the vena comitans.

Comparison of Cleft Lip Nasal Deformities Between Lesser-Form and Incomplete Cleft Lips: Implication for Primary Rhinoplasty.

This study investigated various manifestations of nasal deformities in lesser-form cleft lips, including the minor-form, microform, and mini-microform, by photogrammetric comparison with incomplete cleft lips. Retrospective study. Tertiary university-affiliated hospital. A total of 160 patients with unrepaired unilateral incomplete cleft lips ranging from lesser-form to two-thirds way clefts. The severity of nasal deformities was assessed by photogrammetric measurements of linear and angular variables. The symmetry ratio between the cleft and non-cleft sides was obtained by measuring various nasal parameters and comparing them among the different labial cleft groups. The degree of nasal deformities increased with the extent of labial clefts among the 3 labial cleft groups (lesser-form, halfway, and two-thirds way clefts) in terms of alar base width ratio (1.102, 1.197, 1.309; P < .05), nostril width ratio (1.287, 1.387, 1.551; P < .05), and columellar angle (11.5, 14.45, 18.197; P < .05). Each parameter indicated lesser-form, halfway, and two-thirds way clefts, respectively. However, only the lateral lip height ratio (0.942, 0.851, 0.87; P < .05) and nostril width ratio (1.207, 1.35, 1.29; P < .05) significantly differed among the 3 subgroups. Each parameter indicated mini-microform, microform, and minor-form, respectively. The cleft nasal deformities in lesser-form cleft lip present comparable severities among its subtypes, which implies that the extent of the labial cleft is not correlated with nasal deformities. Each nose in the lesser form cleft should be individually assessed for primary rhinoplasty and requires tailored correction.

Reverse Facial-submental Artery Island Flap with Reinnervation of the Anterior Belly of the Digastric Muscle.

Reconstruction of the upper lateral lip subunit is challenging, and use of several classical local flaps have been previously reported. However, these methods have drawbacks such as visible scarring, anatomic distortion, and functional disability. To obtain satisfactory results, preservation of perioral function is important. We report a case of functional upper lip reconstruction after tumor resection using a reverse facial-submental artery island flap with a reinnervated anterior belly of the digastric muscle (ABDM) without sacrificing the perioral structure. A 73-year-old man presented with basal cell carcinoma on the left upper lip which was widely excised, including the orbicularis oris muscle. The remaining 4 cm × 3.5 cm defect was reconstructed using a reverse facial-submental artery island flap with ipsilateral ABDM. The motor nerve of the ABDM was sutured with the stump of the buccal branch of the ipsilateral facial nerve. The postoperative course was uneventful, and good functional and esthetic recovery were observed at 12-month follow-up. This procedure may be an alternative option for reconstruction of lateral upper lip defects.

Bulbophyllum guniuensis (Orchidaceae: Epidendroideae; Malaxideae), a new species from Eastern China

Bulbophyllum guniuensis W.Y. Ni &amp; J.W. Shao, a new species of Orchidaceae from Anhui Province, eastern China, is described and illustrated. This new species is similar to B. henanense in overall plant size and leaf morphology, but differs from the latter by the length of the scape and the morphology of the lateral sepals and lip. B. guniuensis is also similar to B. hirundinis in margin fimbriate-ciliate, 3-veined dorsal sepal and petals, but differs from it in oblique oblong (vs. linear) lateral sepals and pale yellow to orange yellow (vs. purplish-red to yellow) flowers.

The Role of Nasal Sill Correction in Secondary Cleft Rhinoplasty.

Evaluating outcomes after cleft rhinoplasty can be challenging because of the lack of objective measures that would lead to a more desirable outcome. This study is a 10-year retrospective review of 30 consecutive patients who underwent secondary unilateral cleft rhinoplasty performed by a single surgeon. Subjective ratings were made using the Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE), which rates 4 components (nose, cupid's bow, lateral lip, and free vermillion) with a score of 0 to 2. Multiple anthropometric measurements (nostril height ratio, width ratio, medial ¼ height ratio, sill ratio, nostril area ratio, columellar angle, tip projection ratio, and nasolabial angle) were taken using a free National Institutes of Health program, ImageJ. Standardized photographs were compared at T0 (preoperatively), T1 (<6 weeks postoperatively), and T2 (>6 weeks postoperatively). There were 30 patients who met our inclusion criteria: 10 males (66.7%) and 20 females (66.7%). Of these patients, 26 (86.7%) had a complete cleft lip and 4 (13.3%) had an incomplete cleft lip. The patients' average age at time of surgery was 16.2 years with a mean follow-up of 17.9 months. Subjective scores in both nasal and overall UCL SOE ratings improved from T0 to T1, 0.7 to 1.2 (P ≤ 0.001) and 3.6 to 4.7 (P ≤ 0.001), respectively. Visual analog scores in nasal and overall UCL SOE ratings improved between T0 and T2, 0.7 to 0.9 (P = 0.023) and 3.6 to 4.8 (P = 0.002), respectively. Of all the objective measures, nasal sill ratio and cleft height to width ratio correlated with improved subjective ratings across multiple time points. Our study shows that objective measures such as nasal sill and nostril shape (cleft height to width ratio) correlate with improved subjective visual analog scale using the UCL SOE. The nasal sill is an often overlooked, yet essential, part of creating an aesthetically pleasing nose during cleft rhinoplasty.

Comparative anatomy of the rostrosoma of Solifugae, Pseudoscorpiones and Acari

We compare the microscopic anatomy of the mouthparts of representative species of Solifugae, Pseudoscorpiones and Parasitiformes (Acari). Specifically, we focus on the epistome, the labrum, the lateral lips (= endites of the pedipalpal coxae) and the musculature of the pharyngeal suction pump. We provide evidence that the labrum is reduced in Solifugae, but present and functional in Pseudoscorpiones and Acari. The epistome constitutes the entire dorsal face of the rostrosoma in Solifugae, but is internalized into the prosoma in Pseudoscorpiones. In Acari, the epistome shows an ancestral morphology, probably close to the ground pattern of chelicerates. The lateral lips of Solifugae contribute to the ventral face of the rostrosoma and the two lips of the mouth opening. In Solifugae, the ventral rostrosoma also includes a sclerite that might derive from a tritosternum. In Pseudoscorpiones, the lateral lips remain independent of the rostrosoma, they interlock ventral to the rostrosoma forming a perioral space. Here, the rostrosoma has an unpaired ventral lip of unresolved morphological origin, which is, however, clearly distinct from the lateral lips of Solifugae. The pharyngeal suction pump differs in all three clades in attachment, number of muscles and origin of muscles. We interpret the data as evidence for independent, parallel evolution of elements of the ground pattern of the (eu)chelicerate mouth parts. Based on the morphological elements of a common euchelicerate ground plan, the rostrosoma evolved independently in the three clades. We reject earlier hypotheses that consider the rostrosoma a character to support a phylogenetic relationship of the three clades.

Commentary: Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity.

Sir: We would like to congratulate the authors on an important study that clarifies dogma regarding the unilateral cleft lip nasal deformity.1 A common misperception is that the cleft-side alar base is displaced lateral, and that correction requires medial advancement (Fig. 1A). Just as we have, the authors provide objective evidence of the reverse2: relative to facial midline, the non-cleft alar base is displaced laterally and needs to be centralized (Fig. 1B). Mulliken has proposed that surrounding regional contours may lead to optical illusions of alar base position.3 We feel that the misperception may be due to human cognitive tendencies to reference the more natural appearing non-cleft side when explaining the less-familiar cleft-side contours. Regardless, a clear understanding of the deformity is critical to improving treatment and avoiding iatrogenic anomalies.Fig. 1.: A, Optical illusion. In the absence of facial regions outside the nasolabial region it may seem that correction of the deformity involves downward rotation of the medial lip philtrum and medial advancement of the lateral lip and alar base. B, Context. Facial features and reference lines make the actual displacements readily perceived. The non-cleft alar base and columella need to be centralized, and the cleft alar base needs to be advanced anteriorly. If the lateral lip and alar base were advanced medially, it would produce further imbalance, aggravate the nasal twist, and introduce iatrogenic deformity. Modified with permission from Plast Reconstr Surg 2020:145;185–199.Sakamoto et al analyzed a large sample of photographs and suggested that the cleft alar base is displaced medial relative to age-matched controls.1 Their findings differed from ours in that we found the cleft alar base to be retruded, but normal in medial-lateral position.2 Although they attributed the discrepancy to their larger sample size,1 there are several other explanations to consider. First, whereas our study examined standardized 3D images, they used 2D photographs that involve considerable error from lens distortions, parallax, and uncontrolled head rotation. The appearance of depth from a retruded cleft alar base on 2D images could be extrapolated as variation in medial-lateral position, and error from parallax may be magnified when images are tilted to normalize head position. Second, whereas we measured alar base position using calibrated images with accuracy to within 1 mm, they normalized dimensions on non-standardized photographs using inter-endocantion distance expressed as ratios. These ratios don’t account for the fact that the inter-endocanthion distance widens with increasing cleft severity.2 The findings that Sakamoto et al report may therefore simply be a changing denominator rather than true alteration of cleft alar base position. Although further analysis of well-controlled 3D images would be helpful, the medial position of cleft alar base relative to controls that they report is minimal and may not be of clinical relevance. Most figures depicting unilateral cleft lip nasal deformity crop out facial features beyond the nasolabial region and some research studies advocate that doing so reduces bias when rating esthetic outcomes.4 We are glad to see that Figure 4 in Sakamoto’s article1 is identical to Figure 1 in ours.2 The midline and the endocanthion verticals illustrate the medial-lateral displacements, whereas the alar base horizontals illustrate the relative vertical disparities. Visualization of the whole face allows balance to be judged, and the reference lines guide us to correct perceptions (Fig. 1). We propose that those references should be standard and caution against future research that crops out non-nasolabial regions without providing a mechanism to judge balance. Finally, based on Sakamoto’s,1 Fisher’s,5 and our2 studies, we propose that centralizing the columella and rebalancing the nasal base elements should be the fundamental principle in the correction of the unilateral cleft lip nasal deformity. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

The Melbourne Classification of the Complete Unilateral Cleft Lip Based on Hypoplasia

Background:The hypoplastic lateral lip element within the cleft lip presentation is a recognized entity that has been recently shown to be more common on the right side. The spectrum of such change is yet to be defined. The authors propose the Melbourne classification system of cleft lip hypoplasia and see it as an important step towards discerning the relevance of these anatomical observations to the management of cleft lip/palate patients.Methods:This is a retrospective observational study of patients with complete unilateral cleft lips treated by the senior author (DKC) at the Royal Children's Hospital, Melbourne. Patient charts were retrospectively reviewed and patients were classified into different degrees of hypoplasia based on preoperative, intraoperative, and postoperative photography. Data was reported using descriptive statistics.Results:Fifty-nine patients with complete unilateral cleft lip deformity were grouped according to lateral lip element hypoplasticity. Twenty patients had right-sided clefts and 39 patients had cleft lips on the left side. Of those with right-sided clefts, 18 patients had evidence of hypoplasia (90%). Three patients had Type 1 deformities, 3 patients were Type 2, and 12 patients were Type 3. Patients with left-sided clefts were found to have hypoplasia less frequently with 15 patients showing evidence (38.5%).Conclusions:The authors report a classification system of hypoplasia involving the lateral lip element in complete unilateral cleft lip. The authors propose this classification system as a new measure of cleft severity that will have implications for patient expectations, surgical planning, and future outcome studies.

Identification of neural progenitor cells and their progeny reveals long distance migration in the developing octopus brain.

Cephalopods have evolved nervous systems that parallel the complexity of mammalian brains in terms of neuronal numbers and richness in behavioral output. How the cephalopod brain develops has only been described at the morphological level, and it remains unclear where the progenitor cells are located and what molecular factors drive neurogenesis. Using histological techniques, we located dividing cells, neural progenitors and postmitotic neurons in Octopus vulgaris embryos. Our results indicate that an important pool of progenitors, expressing the conserved bHLH transcription factors achaete-scute or neurogenin, is located outside the central brain cords in the lateral lips adjacent to the eyes, suggesting that newly formed neurons migrate into the cords. Lineage-tracing experiments then showed that progenitors, depending on their location in the lateral lips, generate neurons for the different lobes, similar to the squid Doryteuthis pealeii. The finding that octopus newborn neurons migrate over long distances is reminiscent of vertebrate neurogenesis and suggests it might be a fundamental strategy for large brain development.

A Guide to Bilateral Cleft Lip Markings: An Anthropometric Study of the Normal Cupid's Bow.

The aim of this study was to define the ratio of the heights of the vermilion between the peaks and trough of the Cupid's bow and hence assist in defining the point of closure on the lateral lip element to achieve a balanced Cupid's bow in bilateral lip repair based on our findings. This study is a retrospective observational study of the anthropometrics of the upper lip's Cupid's bow. Three-dimensional (3D) images of toddlers between 2009 and 2016 were extracted from a normative 3D image database of toddlers at the Royal Children's Hospital, Melbourne. Participants from the normative 3D image database at the age of 1 year were studied. This excluded any patients with prior trauma or surgical intervention of the nasolabial region. Landmarks measured were right and left crista philtri (cphR and cphL), labial superius (ls), stomion (sto), right and left chelion, and labial fissure (lf). Vermilion height of the right peak, trough, and left peak of the Cupid's bow was calculated by analyzing the vertical linear distance between cphR-lf, ls-sto, and cphL-lf. The ratio between the median and paramedian heights were recorded. The paramedian height of the upper lip vermilion is consistently greater than the midline height. There was no significant sexual dysmorphism between ratio of paramedian to midline height on the right (P = .538) and left (P = .410). We describe an anthropometric observation of the vermilion relationship at the Cupid's bow and define a specific lateral lip marking for bilateral cleft lip repair based on our anthropometric findings.

Prevalence of the additional head of quadriceps femoris in the South Indian population: a cadaveric and radiological study

Quadriceps femoris is an extensor muscle in the anterior compartment of thigh and is traditionally taught to be composed of four heads. Recently, there is an increased interest in the occurrence of an additional muscle head of quadriceps femoris. But scientific knowledge regarding its incidence is lacking in the South Indian population. This study was done to confirm the presence of the additional head by routine anatomic dissection and radiological imaging techniques. Forty-one formalin fixed human cadaveric lower limbs were dissected and the morphology of the additional head was noted. Retrospective analysis of 88 MRI images of patients was done. The additional muscle head was present in 43.9% of the cadaveric lower limbs and was consistently located between the vastus lateralis and vastus intermedius. It originated from variable portions of the greater trochanter, intertrochanteric line, lateral lip of linea aspera and lateral surface of the shaft of femur and inserted either as a muscle belly or as an aponeurosis into the vastus intermedius (55.6%), vastus lateralis (22.2%) or directly into the base of the patella. It received its vascular supply from branches of the lateral circumflex femoral artery and was innervated by branches from the posterior division of the femoral nerve. In addition, the additional muscle head was identified by MRI and its incidence was reported to be 30.68% for the first time in living subjects. The result of this study provides additional information in understanding the morphology of the quadriceps femoris muscle.

A New Technique of Unilateral Cleft Lip Repair with Scarless Cupid's Bow Peaks.

A novel technique for primary unilateral cleft lip repair with scarless Cupid's bow peaks is described. This technique focuses on the curvature of the Cupid's bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid's bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon. The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid's bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid's bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty. The Noordhoff point was kept as the peak of the Cupid's bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid's bow, was well maintained. The present technique allows for the fashioning of a reliable intended peak of the Cupid's bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients.

Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and non-cleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 ± 0.15, and the lateral lip height ratio was 0.91 ± 0.09 (P < 0.001). No significant differences were observed in lip width and vermilion height between the cleft and non-cleft sides of the upper lip of 6-year-olds; the alar base width ratio was 1.22 ± 0.16, medial lip height ratio was 1.11 ± 0.11, and lateral lip height ratio was 0.89 ± 0.09 (P < 0.05). There were no significant differences in the alar projection and nasal dome height on the cleft side of the nose; the nostril height and width ratios were 0.82 ± 0.11 and 1.31 ± 0.21 (P < 0.001), respectively. These consecutively performed lip adhesions for patients with wide unilateral complete cleft lip resulted in excellent long-term results. Therefore, lip adhesion for wide unilateral complete cleft lip is a reasonable alternative to presurgical molding.

Principalization of the Anatomical Subunit Approximation Technique of Unilateral Cleft Lip Repair

Background: The Anatomical Subunit Approximation cleft lip repair advantageously achieves a balanced lip contour with the line of repair placed along seams of aesthetic subunits. Since Fisher’s original description, it has been adopted widely and adapted, but some surgeons find the transition away from a cut-as-you-go approach challenging. Methods: We present an adapted Anatomic Subunit Approximation technique based on essential components of Fisher’s repair. The order of surgical execution is emphasized. Paradigm shifts are presented to help the surgeon used to more traditional rotation advancement techniques understand the Subunit philosophy. Minor adaptations such as surgically releasing lateral lip elements prior to marking are discussed. Results: A total of 53 eligible patients were treated with unilateral cleft lip repair by the senior author (D.C.) between February 2008 and April 2012 at Royal Children’s Hospital in Melbourne, Australia. Representative cases were chosen to demonstrate achievable results with the described technique. Conclusion: The proposed technique employs essential skin markings to achieve an anatomic subunit approximation lip repair, and appears to facilitate surgical outcomes with a high degree of symmetry. Core principles of repair include precise anatomical planning, tissue component separation, and muscle-driven advancement.

A proximal radius of Barberapithecus huerzeleri from Castell de Barberà: Implications for locomotor diversity among pliopithecoids

Pliopithecoids are a diverse group of Miocene catarrhine primates from Eurasia. Their positional behavior is still unknown, and many species are known exclusively from dentognathic remains. Here, we describe a proximal radius (IPS66267) from the late Miocene of Castell de Barberà (Vallès-Penedès Basin, NE Iberian Peninsula) that represents the first postcranial specimen of the pliopithecoid Barberapithecus huerzeleri. A body mass estimate based on the radius is compared with dental estimates, and its morphology is compared with that of extant and fossil anthropoids by qualitative means as well as by landmark-based three-dimensional geometric morphometrics. The estimated body mass of ∼5 kg for IPS66267 closely matches the dental estimates for the (female) holotype, thereby discounting an alternative attribution to the large-bodied hominoid recorded at Castell de Barberà. In multiple features (oval and moderately tilted head with a pronounced lateral lip and a restricted articular area for the capitulum; proximodistally expanded proximal radioulnar joint; and short, robust, and anteroposteriorly compressed neck), the specimen differs from hominoids and resembles instead extant nonateline monkeys and stem catarrhines. The results of the morphometric analysis further indicate that the Barberapithecus proximal radius shows closer similarities with nonsuspensory arboreal cercopithecoids and the dendropithecid Simiolus. From a locomotor viewpoint, the radius of Barberapithecus lacks most of the features functionally related to climbing and/or suspensory behaviors and displays instead a proximal radioulnar joint that would have been particularly stable under pronation. On the other hand, the Barberapithecus radius differs from other stem catarrhines in the less anteroposteriorly compressed and less tilted radial head with a deeper capitular fovea, suggesting a somewhat enhanced mobility at the elbow joint. We conclude that pronograde arboreal quadrupedalism was the main component of the locomotor repertoire of Barberapithecus but that, similar to other crouzeliids, it might have displayed better climbing abilities than pliopithecids.

Primary Repair of Bilateral Cleft Lip Deformity and Absent Prolabium With a Full-Thickness Skin Graft.

Bilateral cleft lip deformities makeup 10% of orofacial clefts and are uncommon when compared to unilateral cleft lip.1,2 These cleft deformities have significant physical and long-term psychosocial effects on not only the patient but their family. With bilateral cleft lip deformity, the cutaneous approximation of the lateral lip segments are dependent on a sufficient prolabium to reconstruct the philtrum.3,4 Deficient skin equates to tight midline closure and subsequent unsightly scarringIn the subclinical phenotype of bilateral cleft lip and palate, where the patient has an absent or deficient prolabium, achieving tension free closure in the primary surgical setting is a reconstructive dilemma.5 This clinical report describes the use of a full-thickness skin graft to reconstruct the philtrum in a 12-month-old boy with bilateral cleft lip deformity, absent prolabium, absent columella and absent nasal septum to provide an aesthetic subunit repair.

A new root-knot nematode, Meloidogyne vitis sp. nov. (Nematoda: Meloidogynidae), parasitizing grape in Yunnan.

An unknown root-knot nematode was found at high density on grape roots collected from Yunnan Province. Morphometric traits and measurements, isozyme phenotypes, and molecular analysis clearly differentiated this nematode from previously described root-knot nematodes. This new species is described, illustrated and named Meloidogyne vitis sp. nov. The new species can be distinguished from other Meloidogyne spp. by a unique combination of characters. Females display a prominent neck, an excretory pore is located on the ventral region between 23rd and 25th annule behind lips, an EP/ST ratio of approximately 2.5 (1.98-2.96), a perineal pattern with two large and prominent phasmids, and a labial disc fused with the medial lips to form a dumbbell-shaped structure. Males display an obvious head region, a labial disc fused with the medial lips to form a dumbbell-shaped structure, no lateral lips, a prominent slit-like opening between the labial disc and medial lips, a distinct sunken appearance of the middle of the medial lips, and four incisures in the lateral field. Second-stage juveniles are characterized by a head region with slightly wrinkled mark, a labial disc fused with the medial lips to form a dumbbell-shaped structure, a slightly sunken appearance of the middle of the medial lips, a slit-like amphidial openings between the labial disc and lateral lips, and four incisures in the lateral field. The new species has rare Mdh (N3d) and Est phenotypes (VF1). Phylogenetic analysis based on ITS1-5.8S-ITS2, D2D3 fragments of rDNA, and coxI and coxII fragments of mtDNA sequences clearly separated the new species from other root-knot nematodes, and the closest relative was Meloidogyne mali. Meloidogyne mali was collected for amplifying these sequences as mentioned above, which were compared with the corresponding sequences of new species, the result showed that all of these sequences with highly base divergence (48-210 base divergence). Moreover, sequence characterized amplified region (SCAR) primers for rapid identification of this new species were designed.

Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis.

This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.

The unilateral cleft lip repair

ObjectiveTo determine if there is a benefit of 2-stage cleft lip repair in regard to improving facial symmetry and facilitating definitive lip, nose, and palate repair. Study designRetrospective chart review of patients born with complete, unilateral cleft lip deformity that underwent a two-stage repair described as a stage 1 straight line repair and a stage 2 modified Millard repair, for which a complete set of records, and peri-operative and post-operative photos were available. All cases were performed by a single surgeon. SettingTertiary care center craniofacial team. MethodsMeasurements were taken from intraoperative, perioperative, and postoperative images of patients before and after each stage. Ratios were then created comparing the affected size to the unaffected side, and these were averaged between observers. ResultsA 19% increase in the width of area of the presumptive C flap was obtained between the unrepaired and the post-stage I images. The nostril width of the cleft side was 1.2× the width of the unaffected side, demonstrating a 140% decrease in nostril width at the completion of stage II. The cleft side nostril width was maintained slightly larger than the noncleft side as desired. Symmetry of the upper lip length was achieved, as the length of the cleft side lateral lip after stage II was 92% of the unaffected side. ConclusionWe believe this study provides evidence for our observations that a two-stage repair can be performed with functionally and aesthetically pleasing outcomes as an alternative to presurgical nasoalveolar molding.

Morphological and Molecular Characterization of Kochinema farodai Baqri and Bohra, 2001 (Dorylaimida: Nordiidae) from California, with the First Molecular Study and an Updated Taxonomy of the Genus.

Simple SummaryIn this paper, a population of a free-living nematode collected from Northern California (USA) is identified and studied. The aim of the present work is to characterize a Californian population of the nematode genus Kochinema, with morphological and molecular methods. In addition, a revision of this genus is also provided including an updated diagnosis, a list of species, a key to species identification, and a compendium of their main morphometrics and distribution data.This paper deals with the morphological and molecular characterization of Kochinema farodai Baqri and Bohra, 2001, with an integrative approach. The finding of K. faroidai in California is a remarkable biogeographical novelty, as it is the first American record of the species. Molecular data herein obtained represent the first molecular study of the genus Kochinema. Furthermore, scanning electron microscopy (SEM) observations of a member of Kochinema are provided for the first time. Additionally, this contribution provides new insights into the phylogeny and taxonomy of the nematode genus Kochinema. A brief historical outline of the matter is presented. Then, the morphological pattern of the genus is revised and illustrated, the anterior position of amphids, whose opening is located on lateral lip, being its most relevant diagnostic feature. The phylogenetic analysis inferred from D2–D3 expansion segments of 28S rRNA gene shows that Kochinema clustered together with other dorylaimid species characterized by the absence of pars refringens vaginae and that it does not share a recent common ancestor with other members of the family Nordiidae. A likely polyphyly of the family Nordiidae is confirmed. Finally, an updated taxonomy of the genus is proposed, including a revised diagnosis, a list of species, a key to species identification, and a compendium of their main morphometrics and distribution data.