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Petrin AL, Machado-Paula L, Hinkle A, Hovey L, Awotoye W, Chimenti M, Darbro B, Ribeiro-Bicudo LA, Dabdoub SM, Peter T, Murray J, Van Otterloo E, Rengasamy Venugopalan S, Moreno-Uribe LM. Whole genome sequencing of a family with autosomal dominant features within the oculoauriculovertebral spectrum. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.07.24301824. [PMID: 38370836 PMCID: PMC10871465 DOI: 10.1101/2024.02.07.24301824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Oculoauriculovertebral Spectrum (OAVS) encompasses a wide variety of anomalies on derivatives from the first and second pharyngeal arches including macrostomia, hemifacial microsomia, micrognathia, preauricular tags, ocular and vertebral anomalies. We present the genetic findings of a large three-generation family with multiple members affected with macrostomia, preauricular tags and uni- or bilateral ptosis following an autosomal dominant segregation pattern. Methods We generated whole genome sequencing data for the proband, affected parent and unaffected paternal grandparent followed by Sanger sequencing on 23 family members for the top 10 candidate genes: KCND2, PDGFRA, CASP9, NCOA3, WNT10A, SIX1, MTF1, KDR/VEGFR2, LRRK1, and TRIM2. We performed parent and sibling-based transmission disequilibrium tests and burden analysis to explore segregation and burden of candidate gene mutations. Bioinformatic analyses investigated the biological connection between genes and the abnormal phenotypes. Results Overall, rare missense mutations in SIX1, KDR/VEGFR2, and PDGFRA showed the best evidence of segregation with the OAV phenotypes in this family. When considering affection with any of the 3 OAVS phenotypes as an outcome, parent-TDTs and sib-TDTs (unadjusted p-values) found that SIX1 (p=0.025, p=0.052), followed by PDGFRA (p=0.180, p=0.069) and KDR/VEGFR2 (p=0.180, p=0.069) have the strongest associations in this family. Burden analysis via a penalized linear mixed model identified SIX1 (RC=0.87) and PDGFRA (RC=0.98) as having the strongest association with OAVS severity. Using phenotype-specific ogfrautcomes, sib-TDTs identified associations between (1) SIX1 with uni- or bilateral ptosis (p=0.049) and ear tags (p=0.01), (2) PDGFRA and KDR/VEGFR2 with ear tags (both p<0.01). Conclusion Our study reports the genomic findings of a large family with multiple individuals affected with OAVS phenotypes with autosomal dominant inheritance. Our findings narrow down to three potential candidate genes, SIX1, PDGFRA, and KDR/VEGFR2. Among these, SIX1 has been previously associated with OAVS ear malformations and it is co-expressed with EYA1 during ear development. Attempts to strengthen the genotype-phenotype co-relation underlying the OAVS of phenotypes are essential to discover the etiological factors leading to this complex and burdensome condition as well as for family counseling and prevention efforts.
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Affiliation(s)
- A L Petrin
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - Lam Machado-Paula
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - A Hinkle
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - L Hovey
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - W Awotoye
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - M Chimenti
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - B Darbro
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - S M Dabdoub
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - T Peter
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - J Murray
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - E Van Otterloo
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | | | - L M Moreno-Uribe
- College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
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Kim JH, Lim SY. Evaluation of Long-Term Outcomes of Transverse Facial Cleft Repair. Cleft Palate Craniofac J 2024; 61:326-331. [PMID: 38092680 DOI: 10.1177/10556656231207205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of linear commissuroplasty and linear skin closure with a focus on commissural migration. DESIGN Retrospective study. PATIENTS Individuals who underwent transverse facial cleft repair at a single institution between 2004 and 2021. INTERVENTIONS The disrupted orbicularis oris muscle was reoriented and sutured. A simple linear commissuroplasty technique was used, and the cheek skin was closed linearly without Z-plasty. MAIN OUTCOME MEASURES The distances from Cupid's bow peak to the oral commissure were measured bilaterally, and the difference between the normal and cleft sides was obtained. Finally, its proportional value as a percentage of the total lip length was calculated from short- and long-term follow-up photographs. Cheek scarring and its effects on melolabial fold breakage were evaluated. RESULTS Of the 18 patients who underwent transverse facial cleft repair, 12 were included in this study. The mean follow-up period based on medical photographs was 1773.5 days. The average proportional difference was 4.6%, demonstrating no observable commissural migration. There were no consistent trends in the direction of migration, either on the cleft or normal side. In patients with a transverse cleft crossing the melolabial fold, the folds appeared broken before and after the cleft repair surgery. CONCLUSIONS No significant long-term commissural migration was observed after transverse facial cleft repair with simple linear commissuroplasty and linear skin closure. Deliberate positioning of the new oral commissure, proper myoplasty, and meticulous skin closure with minimal scar burden can be considered key procedures for successful transverse cleft repair.
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Affiliation(s)
- Ju Hee Kim
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Lim
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Oliver C, Prévost A, Cavalier Z, Corre P, Lauwers F, Bertin H. Correction of congenital macrostomia by double reversing Z-plasty: A technical note. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:527-531. [PMID: 35346869 DOI: 10.1016/j.jormas.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Congenital macrostomia is a rare congenital deformity that consists of an enlargement of the commissure of the mouth. The malformation may be unilateral or bilateral and has a polymorphic presentation. Various surgical techniques have been described to correct macrostomia, with only a few cases illustrating the expected results. The surgical repair must consider both esthetic as well as functional impacts for the patient. We here propose a technical note to refine and provide additional information for good achievement of "Double Reversing Z-Plasty" for correction of macrostomia. Our case series also reports good long-term functional and esthetic results obtained with this technique, especially in case of a minor cleft.
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Affiliation(s)
- Charlotte Oliver
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France
| | - Alice Prévost
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Zoé Cavalier
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Pierre Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Regenerative Medicine and Skeleton (RMeS), Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes, France
| | - Frédéric Lauwers
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Hélios Bertin
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; CRCI2NA INSERM-CNRS-Nantes Université-Université d'Angers - Équipe 9 (CHILD), faculté de médecine, 1 rue Gaston Veil, 44000 Nantes, France.
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Mehra A, Sarma H. Review of two cutaneous closure methods for Tessier 7 repair: Straight-line versus Z-plasty. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huby M, Neiva-Vaz C, Rougier G, Picard A, Vazquez MP, Kadlub N. Commissuroplasty for macrostomia: surgical technique and long-term aesthetic and functional results assessment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:329-336. [PMID: 34224921 DOI: 10.1016/j.jormas.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Macrostomia or lateral cleft lip is a rare congenital deformity. In this article we describe a surgical technique of macrostomia repair developed. The objective of this article is to assess the results of our surgical technique and to validate a method for macrostomia surgical result evaluation. METHODS We included retrospectively patients with unilateral and bilateral macrostomia, operated from 1995 to 2014 in our department. First part of the study was a satisfaction questionnaire completed by patients. The second part was subjective evaluation of frontal photography (closed mouth, wide open and smiling) by surgeons and lay people with a questionnaire. Both group completed a second questionnaire within one to six months. RESULTS Eighteen patients answered the questionnaire. The satisfaction for all patients were considered as very good for 38.9% (n = 7) of patients and good for 44.4% (n = 8). 21 patients were photographed, 5 isolated macrostomia, 13 macrostomia with minor facial asymmetry and 3 with a major asymmetry. Surgeons evaluated the result as very good for isolated macrostomia and good for syndromic macrostomia. Layperson evaluated the result as good in isolated macrostomia and macrostomia with minor facial asymmetry and average with major facial asymmetry. P < 0.0001. The evolution of the results between medical and non-medical assessors in our two questionnaires, were non-significant. CONCLUSION In this study, we propose a new methodology to assess commissuroplasty surgical results, with a 3 type of evaluator: patients, surgeons and laypeople. We present a simple surgical technique, that allows good results in syndromic and isolated macrostomia.
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Affiliation(s)
- Marine Huby
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Cecilia Neiva-Vaz
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Guillaume Rougier
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Arnaud Picard
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Marie-Paule Vazquez
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Natacha Kadlub
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France.
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Koh SH, Jeong YW, Han JJ, Jung S, Kook MS, Oh HK, Park HJ. Orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty in a patient with a transverse facial cleft. Maxillofac Plast Reconstr Surg 2019; 41:55. [PMID: 31844633 PMCID: PMC6885492 DOI: 10.1186/s40902-019-0240-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Transverse facial clefts are Tessier’s number 7 facial cleft among numbers 1–15 in Tessier’s classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear. Case presentation In a patient with a transverse facial cleft, to functionally arrange the orbicularis oris muscle and form the oral commissure naturally, we performed a surgical procedure including orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. Conclusion We achieved good results functionally and esthetically by orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. The surgical modality of our anatomical repair and 3 months follow-up results are presented.
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Affiliation(s)
- Sung-Hyuk Koh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Yeon-Woo Jeong
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
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Khorasani H, Boljanovic S, Knudsen MAK, Jakobsen LP. Surgical management of the Tessier 7 cleft: A review and presentation of 5 cases. JPRAS Open 2019; 22:9-18. [PMID: 32158892 PMCID: PMC7061684 DOI: 10.1016/j.jpra.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/04/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Several variations on the surgical technique for macrostomia repair have been described in the literature. There has been controversy regarding the preferred method for commissuroplasty and skin closure for optimal functional and aesthetic results. The aim of this study is to present these techniques and the most described methods up to date.Further, five patients operated with a combination of techniques are presented. MATERIAL AND METHODS PRISMA guidelines were followed for literature review.Five consecutive patients with unilateral macrostomia operated during a period of one and a half years at our craniofacial department were included in this study. RESULTS 31 studies on macrostomia repair were obtained. The layered closure technique is widely described with several variations on closure of the inner mucosa, orbicularis muscle, commissure and skin. The inner mucosal layer is in most cases sutured with a straight line closure technique. The muscle is most often duplicated and sutured with upper branches overlapping lower branches. The skin is in most cases sutured with either a z- or a w-plasty with variations.The five presented patients all had satisfactory functional and aesthetic results at follow-up. CONCLUSION Many variations of surgical techniques for macrostomia repair have been presented in the past. We believe that each case of macrostomia needs to be assessed with a tailored surgical plan in order to create the best results. A combination of different techniques with Bütow and Botha's and Kaplan's technique as a starting point, is believed to give satisfactory functional and aesthetic results.
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Affiliation(s)
- Hoda Khorasani
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Section 2102, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Denmark
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Zhou L, Zhu H, Shi D, Ren D, Cui Y, Zhao J, Hou Y, Xu T. Transverse facial cleft (macrostomia) repair: Modification of a traditional technique. J Plast Reconstr Aesthet Surg 2019; 72:2041-2048. [PMID: 31562029 DOI: 10.1016/j.bjps.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 06/06/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Outcomes from surgical repair of transverse facial cleft (macrostomia) may not be very satisfactory when conventional methods are used to position the oral commissure to be repaired. To improve patient outcomes, we developed a modified oral commissure positioning and reconstruction method for transverse facial cleft repair. METHOD In the modified positioning method, the oral commissure at the abnormal side was positioned precisely and reconstructed by a combination of two conventional methods, namely, the distance measurement method and the anatomical charateristics method. The function of the orbicularis oris muscle was preserved. Postoperative surgical scar score and oral commissure symmetry score were determined and compared between patients and healthy controls. The scores ranged from one to five, with one representing the best and five indicating the worst results. RESULTS Nine patients aged 4-31 months (7 girls) underwent the modified transverse facial cleft repair surgery. All the patients had unilateral transverse facial cleft with or without microsomia and/or complete cleft lip. The patients were followed up for one to five years. Although average surgical scar scores of patients (close-mouth: 1.8 ± 0.8, range: 1.0-2.8; open-mouth: 1.8 ± 0.9, range 1.0-3.6) remained significantly higher (P < 0.05) than those of the healthy controls (N = 8, close-mouth 1.1 ± 0.4, range: 1.0-1.4, open-mouth: 1.1 ± 0.3, range: 1.0-1.2) 6 months after the surgery, their average close-mouth oral commissure symmetry score (1.9 ± 0.7, range: 1.6-2.8) was similar (P = 0.381) to those of the healthy controls (1.8 ± 0.8, range: 1.0-2.6). CONCLUSIONS The modified procedure appears to lead to promising long-term benefit on restoring oral commissure symmetry.
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Affiliation(s)
- Lian Zhou
- Department of Stomatology, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China.
| | - Hongping Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China
| | - Dianyin Shi
- Department of Stomatology, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China
| | - Dongni Ren
- Medprin Regenerative Medical Technologies Co., Ltd., Guangzhou, Guangdong 510663, China
| | - Yingqiu Cui
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China
| | - Yingzi Hou
- Department of Stomatology, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China
| | - Tao Xu
- Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing 100084, China; Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, China
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Tse RW, Knight RJ, Fisher DM. Anatomic approximation approach to correction of transverse facial clefts. J Plast Reconstr Aesthet Surg 2018; 71:1600-1608. [PMID: 30327120 DOI: 10.1016/j.bjps.2018.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/16/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
Transverse clefts of the oral cavity have significant impacts on both appearance and function. Many methods of repair have been described, but there is no consensus on optimal approach. In addition, dissatisfaction with scars, distortion of appearance, and recurrent deformity have led to complex surgical designs that are difficult to understand and reproduce. We describe a simple approach to repair that is based upon anatomic approximation of lip components and accurate repair of the muscle. Twenty patients underwent repair by the senior author, who devised the approach, and the corresponding author, who adopted it. Eight (62%) patients had right-sided clefts, three (23%) patients had left-sided clefts, and two (15%) patients had bilateral clefts. One patient had an associated branchial cleft remnant, two patients had multiple branchial cleft remnants and tragus deformities, one patient had craniofacial microsomia with microtia, and one patient had a contralateral Tessier 1 cleft. Mean age of the patients at repair was 23 months. All patients achieved normal oral competence, have favorable scars and commissure appearance, and have had no recurrent deformity. None of the patients have required revision. The described surgical approach is reproducible, easy to understand, and can produce favorable outcomes.
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Affiliation(s)
- Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Robert J Knight
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - David M Fisher
- Division of Plastic Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, M5X 1X8, Canada
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Surgical Alternative for Repair of Bilateral Macrostomia. J Craniofac Surg 2018; 29:1437-1440. [PMID: 29916981 DOI: 10.1097/scs.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The transverse or lateral cleft is the second most common type of craniofacial cleft. The authors report a case of bilateral macrostomia in a male newborn and the authors present a refined method of Kaplan technique for correcting macrostomia. The authors' method is characterized by the creation of a single Z-plasty with the transposed central limb placed in the nasogenian crease.
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Raveendran JA, Chao JW, Rogers GF, Boyajian MJ. The "Double" Tessier 7 Cleft: An Unusual Presentation of a Transverse Facial Cleft. Cleft Palate Craniofac J 2018; 55:903-907. [PMID: 27959587 DOI: 10.1597/16-157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Congenital macrostomia, or Tessier number 7 cleft, is a rare craniofacial anomaly. We present a unique patient with bilateral macrostomia that consisted of a "double" transverse cleft on the left side and a single transverse cleft on the right side. A staged reconstructive approach was used to repair the "double" left-sided clefts. This staged technique produced a satisfactory aesthetic and functional outcome.
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Macrostomia: a review of evolution of surgical techniques. Case Rep Dent 2014; 2014:471353. [PMID: 25400956 PMCID: PMC4220568 DOI: 10.1155/2014/471353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/03/2014] [Accepted: 09/13/2014] [Indexed: 11/17/2022] Open
Abstract
Macrostomia is a congenital deformity resulting from failure of fusion of maxillary and mandibular process. It is a rare congenital deformity with an incidence of 1 in 60,000 to 1 in 300,000 live births. Transverse facial clefts are more common on right side of face in unilateral cases. Males are more affected than females. Various surgical techniques have been described in the literature for the correction of these defects. We report a case of macrostomia corrected with Z-plasty closure for skin, overlapping muscle closure, and triangular mucosal flap for commissure, with a review on existing techniques.
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Abstract
BACKGROUND Macrostomia is a rare facial cleft, with an incompletely described pathogenesis. This series highlights cases of isolated macrostomia presenting with several distinct phenotypes. We examine phenotypic differences in macrostomia patients, to further elucidate the etiopathogenesis. MATERIALS AND METHODS We performed a retrospective review of macrostomia patients evaluated during a 10-year period. Patient demographics and clinical features are reported. RESULTS We identified 25 macrostomia patients (13M/12F). Right-sided macrostomia occurred in 15, left-sided macrostomia occurred in 6, and bilateral macrostomia occurred in 4 patients. Of the bilateral cases, 100% existed in isolation of craniofacial microsomia (CFM) or other craniofacial abnormalities. Twelve patients presented with macrostomia in isolation of CFM; in this subgroup, the male-to-female ratio was 1:1. Bilateral macrostomia was present in 33% of patients. Unilateral macrostomia occurred more often on the right (5:2). Phenotypes included simple unilateral or bilateral macrostomia (67%), macrostomia associated with severe diastasis of the cheek musculature (8%), macrostomia associated with lateral facial clefts (17%), and diastasis of cheek musculature without significant macrostomia (8%). CONCLUSIONS Macrostomia seen in isolation of CFM presents in phenotypically distinct forms. It is unlikely that a single mechanism is responsible for this range of phenotypes. We believe that both intrauterine trauma and failure of fusion of the mandibular and maxillary processes secondary to an aberration in FGF8 function are responsible. Additionally, diastasis of facial musculature may result from delayed fusion and subsequent decreased mesodermal penetration of the mandibular and maxillary processes.
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Dhingra R, Dhingra A, Munjal D. Repair for congenital macrostomia: vermilion square flap method. Case Rep Dent 2014; 2014:480598. [PMID: 24987533 PMCID: PMC4058892 DOI: 10.1155/2014/480598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/17/2022] Open
Abstract
Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse due to failure of mesodermal migration and merging to obliterate the embryonic grooves between the maxillary and mandibular processes to form the angle of the mouth at its normal anatomic position. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus or bilateral. It is usually partial but rarely complete. Transverse facial clefts are more common in males and more common on the left side when unilateral. The goal of macrostomia reconstruction is to achieve functional, symmetrical, and accurate oral commissure with minimal scar. In this paper, we present a six-year-old girl with unilateral macrostomia with preauricular skin tags and malformation of pinna on ipsilateral side treated with vermillion-square flap method. The scar is placed at the upper lip. At two-month followup, the oral commissures are symmetric, the scars are inconspicuous, and the overall balance of facial contour and lip is excellent. We recommend this method for patients with mild to moderate macrostomia.
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Affiliation(s)
- Renuka Dhingra
- Department of Paedodontics and Preventive Dentistry, Maharaja Ganga Singh Dental College & Research Centre, Sri Ganganagar, Rajasthan 335002, India
| | - Asheesh Dhingra
- Jeewan Multispeciality Centre, 414/4 Jacobpura, Gurgaon 122001, India
| | - Dipti Munjal
- Department of Paedodontics and Preventive Dentistry, Maharaja Ganga Singh Dental College & Research Centre, Sri Ganganagar, Rajasthan 335002, India
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Li J, Liu K, Sbi J, Wang Y, Zbeng Q, Sbi B. Commissural symmetry in unilateral transverse facial cleft patients: an anthropometric study. J Oral Maxillofac Surg 2011; 70:2184-90. [PMID: 22209106 DOI: 10.1016/j.joms.2011.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 10/03/2011] [Accepted: 10/07/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the commissural symmetry and commissural migration among patients with unilateral transverse facial cleft. PATIENTS AND METHODS From 2006 to 2009, 31 patients with unilateral transverse facial cleft were repaired with superiorly based vermillion-mucosal flap and orbicularis oris reconstruction. Linear closure and superiorly rotated and inferiorly rotated Z-plasty were randomly chosen for skin closure. An anthropometric method was used immediately after the repair and at the follow-up examination to evaluate the commissural symmetry in both horizontal and vertical directions. RESULTS A total of 21 patients was followed-up for 19 months on average. Satisfactory horizontal symmetry was obtained right after surgery; however, the new commissure was generally lower than the unaffected commissure. At the follow-up examination, no significant lateral commissural displacement was observed; however, the commissural droop on the cleft side became more noticeable. CONCLUSIONS The anthropometric method used was convenient and reliable for facial symmetry analysis. Rectangular vermillion-mucosal flap and proper muscle reconstruction could prevent the lateral commissural migration caused by skin scar contracture. Both horizontal and vertical symmetry should be considered for macrostomia repair.
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Affiliation(s)
- Jingto Li
- Department of Cleft Lip and Palate Surgery and State Key Laboratory of Oral Disease, West China College of Stomatology, Sichuan University, Chengdu, China
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Fadeyibi IO, Ugburo AO, Fasawe AA, Idris O, Ademiluyi SA. Macrostomia: A study of 15 patients seen in Lagos, Nigeria and proposal for a classification of severity. J Plast Surg Hand Surg 2010; 44:289-95. [PMID: 21446807 DOI: 10.3109/2000656x.2010.517668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Idowu O Fadeyibi
- Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine,Lagos State University Teaching Hospital, Oba Akinjobi Street, Ikeja, Lagos, Nigeria.
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Abstract
The objective of this study was to determine whether the direction of Z-plasty limbs incorporated into the surgical repair for macrostomia had a significant influence on the quality of the resultant scar. A total of 41 patients who underwent macrostomia repair by means of the same technique, and who had a follow up period of at least 2 years, were retrospectively reviewed through postoperative photographs and medical records. Quality of scar, lip symmetry, and commissure shape and thickness were recorded. Our results showed that a more favorable scar would be achieved in the medial limb of the Z-plasty if it was planned parallel to relaxed skin tension lines (P < 0.05). An unfavorable scar would be more likely if the medial limb of the Z-plasty was made in a horizontal direction or perpendicular to relaxed skin tension lines (P < 0.05). The quality of scar in both the central and lateral limbs of the Z-plasty was not significantly influenced by their direction.
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Ahmed SS, Bey A, Hashmi SH, Parveen S, Ghassemi A. Bilateral Transverse Facial Cleft as an Isolated and Asyndromic Deformity. Int J Clin Pediatr Dent 2010; 3:101-4. [PMID: 27507920 PMCID: PMC4968176 DOI: 10.5005/jp-journals-10005-1062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 03/05/2010] [Indexed: 11/23/2022] Open
Abstract
Congenital macrostomia or transverse facial cleft is a rare congenital craniofacial anomaly, which affects the esthetics and functions of oral cavity. It is usually associated with deformities of other structures developed from the first and second branchial arches. Bilateral transverse cleft, occurring alone is uncommon. Since the deformity is rare, its treatment has not been commonly described in the literature. We report a case of congenital bilateral macrostomia as an isolated, asyndromic deformity to add one more case in the literature and surgical technique has been discussed here.
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Affiliation(s)
- S S Ahmed
- Chairman, Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Afshan Bey
- Professor, Department of Periodontics and Community Dentistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - S H Hashmi
- Professor, Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shaista Parveen
- Senior Resident, Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Alirza Ghassemi
- Consultant, Maxillofacial and Plastic and Reconstructive Surgeon, Aachen University Hospital, Pulwaster, Aachen, Germany
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Fadeyibi IO, Ugburo AO, Ogunbanjo CV, Ilombu CA, Ademiluyi SA. The surgical repair of macrostomia. Cleft Palate Craniofac J 2009; 46:642-7. [PMID: 19860489 DOI: 10.1597/07-178.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many surgical techniques have been described for the repair of macrostomia. However, most were designed for the repair of unilateral macrostomia. Most reports of repairs involved small numbers of patients. This has not allowed for evaluation of complications and comparison of various techniques. OBJECTIVE This study describes a modification of an older technique designed for unilateral macrostomia. Details of the operative technique used for the repair are described, along with the principles underlying the various steps. MATERIALS AND METHODS This study involves 13 patients operated for macrostomia using the same surgical technique. The patients were seen at a recent screening and mass surgery exercise for patients with orofacial and craniofacial deformities. RESULTS Eleven patients had bilateral macrostomia; two had unilateral macrostomia. No anesthetic or surgical complications occurred in any of the patients. All patients tolerated the procedure well. Oral continence and acceptable facial symmetry were restored in all patients, with minimal scarring.
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Affiliation(s)
- I O Fadeyibi
- Burns and Plasic Surgery Unit, Department of Surgery, College of Medicine, Lagos State University Hospital, Lagos, Nigeria
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Abstract
BACKGROUND Tessier described rare craniofacial clefts anatomically. The no. 7 cleft is a lateral facial cleft consisting of macrostomia, lateral facial muscular diastasis, and bony abnormalities of the maxilla and zygoma. Early computed tomographic imaging provided preliminary insight into the bony abnormality. This article reviews this patient group, defining the clinical and radiological features, to advise optimal protocol management. METHODS A retrospective case-note review of 15 patients with Tessier no. 7 clefts managed by the Australian Craniofacial Unit over the past 25 years was performed. Cases of hemifacial microsomia and Treacher-Collins syndrome were excluded. Clinical features of the patient group were analyzed with photography (all clefts) and imaging (seven clefts). Surgical management and outcome are reviewed. RESULTS Fifteen patients and 18 clefts (three bilateral) were treated during the time period of the study. All patients had macrostomia (mean length, 2 cm) and 94 percent had soft-tissue ridging from muscular diastasis directed toward the tragus (44 percent), temporal area (28 percent), or lateral canthus (22 percent). Bony abnormalities included simple clefting of the maxillary molar region in 55 percent, maxillary duplication in 39 percent, and intermaxillary fusion in 6 percent. Surgical intervention included macrostomia repair at the first available opportunity, resection of maxillary duplication (median age, 4 years), and alveolar bone grafting to the cleft (median age, 10 years). Optimal follow-up of these patients is impaired because of long distances required for review. Patients treated with this management protocol have had good functional and aesthetic results to date. CONCLUSIONS This article describes the Tessier no. 7 cleft in great detail and suggests a new subclassification of the bony abnormality. An adjusted management protocol is proposed to address the bony abnormalities of cleft and duplication, with favorable outcomes for treated patients with this condition.
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Pepe E, Petricig P, Peretta P, Cinalli G. Bilateral macrostomia associated with aqueductal stenosis and glial heterotopias. Cleft Palate Craniofac J 2007; 44:558-61. [PMID: 17760484 DOI: 10.1597/06-096.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report on an Italian boy, born to normal and nonconsanguineous parents with a prenatal diagnosis of ventriculomegaly and subependymal glial heterotopias. At birth bilateral macrostomia was diagnosed without other evident facial anomalies. Magnetic resonance imaging (MRI) showed triventricular hydrocephalus and aqueductal stenosis and confirmed the nodules of glial heterotopia. The bilateral macrostomia was surgically corrected with the vermilion square flap method and W-plasty technique and follow up MRI at 6 months showed mild increase of ventricular dilatation without signs of active hydrocephalus. The association between macrostomia and hydrocephalus has been reported only in rare cases of complex malformative syndromes but never with isolated macrostomia.
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Affiliation(s)
- Ernesto Pepe
- Department of Plastic Surgery and Pediatric Neurosurgery, Regina Margherita Children's Hospital, Turin, Italy.
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Rogers GF, Mulliken JB. Repair of transverse facial cleft in hemifacial microsomia: long-term anthropometric evaluation of commissural symmetry. Plast Reconstr Surg 2007; 120:728-737. [PMID: 17700125 DOI: 10.1097/01.prs.0000270308.51699.40] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cleft of the oral commissure is an uncommon malformation that results from incomplete mesenchymal merging of the mandibular and maxillary prominences of the first pharyngeal arch. Many operative techniques have been proposed to repair this cutaneous and muscular defect. Most authors recommend cutaneous closure by Z-plasty or W-plasty, but these geometric techniques cause additional cutaneous scarring; furthermore, the risk of commissural migration after repair of a transverse facial cleft is poorly documented. METHODS Anthropometry was used to evaluate the operative outcome in 13 patients with hemifacial microsomia who underwent repair of a transverse facial cleft by the senior author between 1980 and 2001. The procedure included (1) apposition of the orbicularis oris muscle; (2) linear cutaneous closure; and (3) construction of the commissure using an inferiorly based, rectangular vermilion-mucosal flap. RESULTS The average age at repair was 11 months, and the mean follow-up was 10.3 years. Comparing the cleft and noncleft sides, the position of the commissure was within 1 mm in all patients, whereas the melolabial fold was asymmetric in six patients. The average length of the scar was 17 mm, and the scar extended lateral to the melolabial fold in all but one patient. No patients were found to have had lateral commissural migration. CONCLUSIONS The authors conclude that Z-plasty or W-plasty is unnecessary in repair of a transverse facial cleft. Closure of the orbicularis oris muscular ring is the critical step in the procedure to provide oral continence and a counterforce to the contraction of the cutaneous scar. There is no lateral creep of the commissure or hypertrophic scarring after straight-line cutaneous closure.
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Affiliation(s)
- Gary F Rogers
- Boston, Mass. From the Craniofacial Center, Department of Plastic Surgery, Children's Hospital, Harvard Medical School
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Gleizal A, Comiti S, Caquant L, Beziat JL. Étude épidémiologique et clinique des macrostomies. À propos d'une série de dix observations. ANN CHIR PLAST ESTH 2006; 51:217-22. [PMID: 16503373 DOI: 10.1016/j.anplas.2005.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 12/09/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Macrostomia or lateral cleft or commissural cleft or transverse cleft is a rare facial cleft in comparison with standard cleft lip and palate. METHOD A retrospective study of 10 cases of congenital macrostomia is realised. For each case a retrospective study with epidemiologic and clinic features was realised. RESULTS AND DISCUSSION From these clinical considerations, a new classification with direct surgical consequences is proposed.
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Affiliation(s)
- A Gleizal
- Service de chirurgie maxillofaciale, hôpitaux Nord, 93, grande-rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France
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Eguchi T, Asato PH, Takushima A, Takato T, Harii PK. Surgical repair for congenital macrostomia: vermilion square flap method. Ann Plast Surg 2001; 47:629-35. [PMID: 11756833 DOI: 10.1097/00000637-200112000-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital macrostomia (transverse facial cleft) is a relatively rare anomaly. Surgical methods used to correct this anomaly include commissuroplasty, muscle-plasty of the orbicularis oris, and closure of the cleft cheek. The authors report a new vermilion square flap surgical technique that combines a lower lip mucocutaneous vermilion border flap with a lazy W-plasty to ensure a natural commissure and cheek skin closure. This technique was used in 8 patients with satisfactory results.
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Affiliation(s)
- T Eguchi
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Japan
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Affiliation(s)
- M W Yencha
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital, Pensacola, Florida, USA.
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Abstract
Our new surgical procedure with two triangular flaps for macrostomia repair allows us to achieve all three therapeutic goals, including formation of symmetric lips and commissures of the mouth, reconstruction of the orbicularis muscle of mouth to restore labial function, and reconstruction of the commissure of the mouth with a natural looking contour. Furthermore, the position of the commissure of the mouth can be adjusted intraoperatively according to the extent of macrostomia. As reported here, our method provides very satisfactory clinical results and is relatively easy to perform. Thus, we believe that our method can serve as a standard for the surgical treatment of macrostomia.
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Affiliation(s)
- I Ono
- Department of Dermatology, School of Medicine, Fukushima Medical University, Japan.
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