Soft Defects Research Articles

A Modified Feeding Plate for a Newborn with Cleft Palate

Objectives : Cleft palate is a common congenital maxillofacial defect. We wish to present the fabrication of a modified feeding plate that will adapt to the changing palatal and velopharyngeal morphology during function. Case Report : A neonate with unilateral cleft lip and palate was referred to our clinic for the fabrication of a feeding plate. Intraoral examination revealed a cleft involving the uvula and the soft palate, with an alveolar defect on the left side. An impression was taken and a dental cast was obtained. A 1-mm Bioplast clear soft plate was pressed on the model. After trimming the edges of the plate, several retentive holes were made for its attachment to the hard plate. With the Bioplast soft plate replaced on the cast, plaster was used to cover parts of the soft plate that were not to come in contact with the hard plate. Biocryl resin was put on the retentive holes and 2-mm Biocryl C Rosa-transparent plate was pressed. The edges of the plate were cut, trimmed, and polished. Conclusion : This modified feeding plate effectively obstructed the soft palate defect. The adaptation of the flexible bulb of the appliance with the soft palate was excellent. Evaluation with nasoendoscopy revealed the synchronized movement of the bulb of the appliance with the soft palate during swallowing. Soft extension of the feeding plate eliminated the risk of irritation, and the baby accepted the appliance easily.

Topological colloids

Smoke, fog, jelly, paints, milk and shaving cream are common everyday examples of colloids, a type of soft matter consisting of tiny particles dispersed in chemically distinct host media. Being abundant in nature, colloids also find increasingly important applications in science and technology, ranging from direct probing of kinetics in crystals and glasses to fabrication of third-generation quantum-dot solar cells. Because naturally occurring colloids have a shape that is typically determined by minimization of interfacial tension (for example, during phase separation) or faceted crystal growth, their surfaces tend to have minimum-area spherical or topologically equivalent shapes such as prisms and irregular grains (all continuously deformable--homeomorphic--to spheres). Although toroidal DNA condensates and vesicles with different numbers of handles can exist and soft matter defects can be shaped as rings and knots, the role of particle topology in colloidal systems remains unexplored. Here we fabricate and study colloidal particles with different numbers of handles and genus g ranging from 1 to 5. When introduced into a nematic liquid crystal--a fluid made of rod-like molecules that spontaneously align along the so-called 'director'--these particles induce three-dimensional director fields and topological defects dictated by colloidal topology. Whereas electric fields, photothermal melting and laser tweezing cause transformations between configurations of particle-induced structures, three-dimensional nonlinear optical imaging reveals that topological charge is conserved and that the total charge of particle-induced defects always obeys predictions of the Gauss-Bonnet and Poincaré-Hopf index theorems. This allows us to establish and experimentally test the procedure for assignment and summation of topological charges in three-dimensional director fields. Our findings lay the groundwork for new applications of colloids and liquid crystals that range from topological memory devices, through new types of self-assembly, to the experimental study of low-dimensional topology.

Evaluation of masticatory function after maxillectomy using a colour‐changing chewing gum

The purpose of this study was to identify the risk factors associated with the masticatory dysfunction after maxillectomy using a colour-changing chewing gum. Thirty-nine patients who underwent maxillectomy between January 2002 and May 2010 in the Department of Kobe University Hospital were recruited for this study. There were 20 male and 19 female subjects, with a median age of 73·3years (range of 44-90) at the time of surgery. The intra-oral conditions after maxillectomy were classified by HS classification, and the masticatory function was evaluated by a colour-changing chewing gum and the results of a modified Sato's questionnaire. The scores of the colour-changing gum were closely correlated with the scores of the modified Sato's questionnaire (r=0·661, P<0·01). A logistic regression analysis with the outcome variable of the gum test <4 demonstrated that significant predictors for the masticatory dysfunction were the number of anchor teeth ≤2 and a soft palate defect. A colour-changing gum was found to be useful for evaluating the post-operative masticatory function, and it was important to conserve the anchor teeth and the soft palate to avoid masticatory dysfunction.

Liposculpture and Fat Grafting for Aesthetic Correction of the Gluteal Concave Deformity Associated with Multiple Intragluteal Injection of Penicillin in Childhood

The gluteal concave deformity, a complication of repeated intragluteal injections in childhood, is a relatively common complaint of many young women in China. This issue could be addressed by lipofilling, as the method could produce aesthetically acceptable results in correcting soft tissue contour defects. Twelve patients with bilateral gluteal concave deformities associated with repeated intragluteal injections were operated on from June 2006 to June 2010. The deformities were classified as major or minor. Overall satisfaction with body appearance after gluteal fat grafting and liposculpture was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was performed at 3-44months after surgery. The average volume of fat injected was 196.9±41.4ml. No serious adverse events occurred. One patient with major deformity had one additional fat grafting procedure. One patient developed cellulitis in the feet and lower legs, upon which the grafted areas were incised and drained on suspicion of infection but with negative cultures. The patient recovered uneventfully with intravenous antibiotic application for 7days. At the office visit nine cases judged that their appearance after the operation as "very good" (4) to "excellent" (5) and three cases responded that their contour was "good." Improvement in skin texture and alleviation of the pigmentation in the concave area were observed in all cases during the 3-44-month follow-up intervals after the fat grafting, and softening of the hypertrophic scar was also observed as early as 1month after the fat grafting and continuously improved during the 12-month follow-up. Autologous lipografting for gluteal concave deformity, combining a liposculpture procedure adjacent to the defects, accomplishes good aesthetic results with high patient satisfaction. The key to success is complete release of fibrosis adhesion, meticulous manipulation of fat grafts, and multitunnel and multiplane injections to ensure maximum take of the grafts. 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 .

Wave propagation in square granular crystals with spherical interstitial intruders

We investigate the propagation and scattering of highly nonlinear waves in granular systems composed of spheres in contact arranged in a square packing, and study how the presence of small and light spherical interstitial defects, also referred to as intruders, affects the wave propagation. The effects of a single defect are investigated experimentally and compared to numerical simulations, showing very good quantitative agreement. Transmitted and scattered waves are formed, whose characteristics depend on the material properties of the defect in relation to the properties of the particles in the lattice. Experiments and numerical simulations reveal that stiffer defects are more efficient at redistributing energy outside the impacted chain and soft defects induce a localization of the energy at the defect. Finally, the effects of the presence of two defects, placed diagonally or aligned in the square packing are also investigated, as well as how their interaction depends on their relative positions.

Soft Palate Reconstruction Using Bilateral Palatal Mucomuscular Flap and Pharyngeal Flap after Resection of Squamous Cell Carcinoma

Squamous cell carcinoma infrequently occurs at the soft palate. Although various methods can be used for reconstruction of soft palate defects that occur after resecting squamous cell carcinoma, it is difficult to obtain satisfactory results from the perspective of the functional restoration of the soft palate. A combination of bilateral palatal mucomuscular flap for the oral side and superiorly based posterior pharyngeal flap for the nasal side were performed on two patients who were diagnosed with squamous cell carcinoma of the soft palate in order to reconstruct the soft palate defects after surgical resection. After surgery, the patients were followed-up for a mean period of 11 months. The flaps were well maintained in both patients. The donor site defects were epithelialized and completely recovered. Additionally, no recurrence of the primary sites was shown. Slight hyponasality was observed in the voice assessments that were conducted 6 months after surgery. No food regurgitation or aspiration was observed in the swallowing tests. We used a combination of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap to reconstruct the soft palate defects that occurred after resecting the squamous cell carcinomas. We reduced the donor site complications and achieved functionally satisfactory outcomes.

Pectoral Muscle Flap With V-Y Skin Paddle for Covering Sternal Defects

Deep sternal wound infection (DSWI) after a cardiac operation is a rare but serious complication associated with significant morbidity and mortality. It can lead to wound dehiscence with sternal osteomyelitis and both bony and soft tissue residual defects. When the infection is eradicated, reconstruction of the thoracic wall remains the main challenge. Tissue used for covering the defect must be well nourished and sutures must be tension free. We present our unique modification of the method using the pectoral muscle axial flap with a V-Y skin paddle.

Radionécrose thoracique sévère : couverture par lambeau avec préservation partielle du latissimus dorsi (PPLD)

Cutaneous radionecrosis and osteoradionecrosis are severe complications of the radiotherapy which can arise after a variable free interval. The loss of substance is frequently associated with a peripheral radiodermatitis and stays an infectious front door exposing patients to a sepsis. The reference treatment remains surgical and consists in realizing the debridment of necrosis tissues associated with flap in order to cover the soft tissus defect. The purpose of our study is to estimate efficiency and tolerance of management radionecrosis thoracique by muscle-sparing latissimus dorsi flap (MSLD). We realized a study on a series of cases of thoracic radionecrosis with costal exposure covered by MSLD. Fat transfer into peripheral radiodermitis was performed at the same time surgical. Efficiency and tolerance surgery were estimated. The duration of the postoperative antibiotic treatment was estimated. The complications (hematoma, infection, cutaneous suffering, necrosis, seroma, radionecrosis relapse) were screened. The follow-up was realized by the same surgeon. Seven patients managed by the same surgeon were included, They had radionecrosis after radiotherapy for processing adjuvanting of mastectomy after breast cancer. The average age was 66 years (from 61 to 76 years). The average time of hospitalisation was of four days. The average follow-up was of six months. The average treatment of the antibiotic treatment was four weeks. We didn't notice any complications and any recurrence of the radionecrosis. We noticed one dorsal collection (30 cm(3)) 15 days after surgical procedure for one patient. The follow-up showed a stable and good quality cutaneous cover in six months postoperative. MSLD flap is reliable and reproducible to cover moderate thoracic defect. The surgical parage-wash has a fundamental importance to avoid any infectious complication. The management of the thoracic radionecrosis is complex and multidisciplinary. In conclusion, MSLD flap seems to be an elegant surgical alternative insuring a custom-made optimal cover with a reduction of the morbidity of the site donor.

Prosthetic Treatment of Congenital Hard and Soft Palate Defects

Obturator prostheses are used to improve mastication, speech, and swallowing by reestablishing oronasal separation and aesthetics in maxillary defect patients. A sectional and magnetically retained functional removable speech bulb prosthesis was planned to treat the congenitally cleft hard and soft palates of this patient. The obturator part, localized into lateral nasal undercuts covered with sound mucosa, was used to retain the complete denture. Two pieces of the prosthesis were joined together by a magnet in the mouth. A special hinge mechanism was added to join the complete denture and functional velopharyngeal parts of the prosthesis for the treatment of velopharyngeal inadequacy. Sufficient retention was obtained, and no major complications were seen in the patient's prosthesis in periodic controls.

Palatal reconstruction

The palate is a critical structure, playing pivotal roles in speech, swallowing, and mastication. Reconstruction of the palate is among the most difficult challenges faced by head and neck reconstructive surgeons. The primary aims of this review are to catalog the evolution of the classification systems for palatal defects, discuss decision making surrounding the various options for hard palate reconstruction, and address the special challenges and techniques involved in soft palate reconstruction. The Okay Classification System has become the standard by which most hard palatal defects are assessed. Free tissue transfer seems to be becoming an increasingly important therapeutic modality for many hard and soft palate defects. Success in the management of palatal defects depends on accurate appreciation of the size and functional extent of each defect, careful patient selection, and specific attention to each patient's goals.

Mandibular reconstruction using osteocutaneous radial forearm flap.

To describe the use of radial forearm osteocutaneous free flap in complex mandibular reconstruction. A case series. Combined Military Hospital, Rawalpindi, from January 1998 to January 2008. Patients having a small bony component and a large soft tissue mandibular defect requiring reconstruction were selected. These defects include composite through-and-through defects of the cheek in the retromolar trigone, small lateral bony defects with large intra and extra oral soft tissue defects and small central bony defects with large extra oral tissue loss. Radial forearm osteocutaneous free flap was employed. Complications and graft acceptance were determined at follow-up. Patients were followed-up for an average period of 28 months. Complications occurred in 8 patients. Wound infection and partial wound dehiscence were the most common complication observed in 3 patients. Non-union at recipient site was seen in 2 patients. Flap donor site healed uneventfully in all patients with no fractures at the donor site. The radial forearm osteocutaneous flap covers oromandibular defects with large intra-oral and extra oral soft tissue losses. Lateral and anterior mandibular defects were reconstructed satisfactorily in our series.

Reconstruction of the chin using an expanded deltopectoral flap following multiple recurrences of oral cancer

An important alternative to free tissue transfer in patients requiring correction of soft tissue chin defects are local and regional flaps, such as the pectoralis major myocutaneous flap and deltopectoral flap. With predictable vascular supply, potential for large size, and good aesthetic match for facial and cervical skin, the deltopectoral flap can offer the reconstructive surgeon additional options in patients who lack vessels suitable for free tissue transfer. The use of an expanded deltopectoral flap for a staged reconstruction of the chin in a patient with cancer recurrences, concomitant resections, radiation and multiple reconstructions is reported.

Understanding magnetic properties of arrays of small FePt dots with perpendicular anisotropy

FePt dot arrays with dot size down to 15nm are fabricated by film annealing and patterning. The array coercivity shows an increase with dot size decreasing from 100 to 30nm, and a slight reduction for the 15nm dot sample. Annealing these dot arrays at higher temperatures results in large enhancements in the coercivities, except the 15nm dot array where the coercivity increases a little. Micromagnetic models of a 15nm FePt dot with uniform and nonuniform edges of soft magnetic defects and with inside defects are calculated to reveal the microstructure origins of the dot magnetic properties. It is found that the volume fraction of the L10-phase FePt with perpendicular c-axis orientation is about 50% in the dot and the switching field distribution of the dot array can be influenced significantly by the defect arrangement in the dots.

Prosthetic Rehabilitation of Velopharyngeal Insufficiency: A case of Pharyngeal Obturator with palatal lift prosthesis

Palatal defect of any extent causes multiple problems in speech, mastication and esthetics. Cancer resection is the most common cause of acquired palatal defects. Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. A soft palate defect may result from surgical resection, and its consequences could include hypernasal speech and nasal regurgitation of food and liquids. A speech aid prosthesis fabricated for patients can improve nasal emission during speech, and assist in preventing nasal regurgitation of food. This article presents a case of the reconstruction of a soft palate defect by prosthetic obturation.

Proximal-type Epithelioid Sarcoma Arising in the Inguinal Area

Proximal-type Epithelioid Sarcoma Arising in the Inguinal Area

Second‐trimester soft markers: relation to first‐trimester nuchal translucency in unaffected pregnancies

Genetic sonography following first-trimester combined screening appears to increase substantially detection rates for Down syndrome but it relies on the unproved assumption of independence between these tests. In this study we aimed to investigate the relationship between first-trimester nuchal translucency (NT) and a series of second-trimester soft markers and structural defects in unaffected pregnancies. NT measurement in the first trimester was followed by second-trimester scan (18 to 23 + 6 weeks) including examination for three categorical markers (intracardiac echogenic foci, hyperechogenic bowel and structural defects) and measurement of nasal bone length, nuchal-fold thickness, femur length, humerus length, renal pelvis diameter and prenasal thickness. All continuous variables were expressed in multiples of the median (MoM) for gestation and correlation coefficients between log-transformed NT and second-trimester variables were calculated. In addition, frequencies of soft markers and structural defects in cases with increased NT were compared to those with normal NT, using MoM cut-offs. In a dataset of 1970 cases, NT was significantly correlated (P < 0.05) with all second-trimester continuous variables, the correlation being strongest for nuchal-fold thickness (r = 0.10). There was a higher frequency of cases with second-trimester nuchal-fold thickness above the 97.5(th) centile (10.7 vs. 2.2%) and hyperechogenic bowel (2.4 vs. 0.1%) in cases with increased NT. Straightforward reassessment of risk using likelihood ratios derived from the second-trimester genetic sonogram might lead to inaccurate estimates. Multivariate models using continuous second-trimester variables might be preferable in sequential screening strategies.

A new alternative for reconstruction of soft triangle defects secondary to burn injury: Superiorly based columellar flap

A new alternative for reconstruction of soft triangle defects secondary to burn injury: Superiorly based columellar flap

Reconstruction of a Total Soft Palatal Defect Using a Folded Radial Forearm Free Flap and Palmaris Longus Tendon Sling

BackgroundThe soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate.MethodsSix patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation.ResultsMean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function.ConclusionsThe large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

Strategies for Human Adipose Tissue Repair and Regeneration

In plastic and reconstructive surgery there is an increasing demand for malleable implants to repair soft tissue congenital defects, or those resulting from aging, traumatic injury and tumour resection. However, currently available methods present a number of limitations such as volume loss over time and eventual resorption of the graft. Tissue engineering techniques provide promising therapeutic solutions to these inconveniences through development of engineered equivalents that best imitate adipose tissue, both structurally and functionally. Here we review the latest achievements in the human adipose tissue engineering field, with a focus on its regenerative potential for a number of clinical applications.

Reconstruction of the chin using an expanded deltopectoral flap following multiple recurrences of oral cancer

An important alternative to free tissue transfer in patients requiring correction of soft tissue chin defects are local and regional flaps, such as the pectoralis major myocutaneous flap and deltopectoral flap. With predictable vascular supply, potential for large size, and good aesthetic match for facial and cervical skin, the deltopectoral flap can offer the reconstructive surgeon additional options in patients who lack vessels suitable for free tissue transfer. The use of an expanded deltopectoral flap for a staged reconstruction of the chin in a patient with cancer recurrences, concomitant resections, radiation and multiple reconstructions is reported.