\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"5215",leadTitle:null,fullTitle:"Piezoelectric Materials",title:"Piezoelectric Materials",subtitle:null,reviewType:"peer-reviewed",abstract:"The science and technology in the area of piezoelectric ceramics are extremely progressing, especially the materials research, measurement technique, theory and applications, and furthermore, demanded to fit social technical requests such as environmental problems. While they had been concentrated on piezoelectric ceramics composed of lead-containing compositions, such as lead zirconate titanate (PZT) and lead titanate, at the beginning because of the high piezoelectricity, recently lead water pollution by soluble PZT of our environment must be considered. Therefore, different new compositions of lead-free ceramics in order to replace PZT are needed. Until now, there have been many studies on lead-free ceramics looking for new morphotropic phase boundaries, ceramic microstructure control to realize high ceramic density, including composites and texture developments, and applications to new evaluation techniques to search for high piezoelectricity. 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\r\n\tWith the advances in biotechnology, identification of new therapeutic targets, and better understanding of human diseases, pharmaceutical companies and academic institutions have accelerated their efforts in drug discovery. The pipeline to obtain therapeutics often involves target identification and validation, lead discovery and optimization, pre-clinical animal studies, and eventually clinical trials to test the safety and effectiveness of the new drugs. In most cases, screening using genome-scale RNA interference (RNAi) technology or diverse compound libraries comprises the first step of the drug discovery initiatives. Conducting either genome-wide RNAi or small molecule screens has become possible with the advances in high-throughput screening (HTS) technologies, which are indispensable to carry out massive screens in a timely manner.
\r\n\r\n\tThis book will analyze methods developed to meet the needs for handling large datasets generated from HTS campaigns. The growing number of statistical methods for HTS may further accelerate the discovery of drug candidates with higher confidence.
",isbn:"978-1-83962-948-8",printIsbn:"978-1-83962-947-1",pdfIsbn:"978-1-83962-949-5",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"37e6f5b6dd0567efb63dca4b2c73495f",bookSignature:"Prof. Shailendra K. Saxena",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10234.jpg",keywords:"High Throughput Screening, Ultra-High Throughput Screening, Fluorescence Polarization, Fluorescence Anisotropy, Fluorescence Resonance Energy Transfer, Time-Resolved FRET, Standard Deviation, Coefficient of Variation, Compound Management, DNA-Encoded Chemical Library, Laboratory Automation, Synthetic Genetic Array",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 16th 2020",dateEndSecondStepPublish:"December 28th 2020",dateEndThirdStepPublish:"February 22nd 2021",dateEndFourthStepPublish:"May 13th 2021",dateEndFifthStepPublish:"July 12th 2021",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Saxena's H-index 28 is a clear indicator of his high merit as a researcher working on the molecular mechanisms of host defense during human viral infections. He is a Fellow of Royal Societies of Biology and Chemistry, United Kingdom, Academy of Translational Medicine Professionals, Austria, and is named as the Global Leader in Science by The Scientist magazine (USA) and International Opinion Expert involved in the vaccination for JE by IPIC (UK).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://mts.intechopen.com/storage/users/158026/images/system/158026.jfif",biography:"Dr. Shailendra K. Saxena is Vice Dean and Professor at King George's Medical University, Lucknow, India. \r\nHis research interests are to understand the molecular mechanisms of host defense during human viral infections and to develop new predictive, preventive, and therapeutic strategies for them using JEV, HIV and emerging viruses as a model, via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with high citation. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award (UK), Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India, and Fellow of various internationally prestigious societies/academies including Royal Societies of Biology and Chemistry, London, United Kingdom, Academy of Translational Medicine Professionals, Austria, and is named as the Global Leader in Science by The Scientist magazine (USA) and International Opinion Leader/Expert involved in the vaccination for JE by IPIC (UK).",institutionString:"King George's Medical University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"10",totalChapterViews:"0",totalEditedBooks:"6",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"19",title:"Pharmacology, Toxicology and Pharmaceutical Science",slug:"pharmacology-toxicology-and-pharmaceutical-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"247865",firstName:"Jasna",lastName:"Bozic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/247865/images/7225_n.jpg",email:"jasna.b@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"3311",title:"Current Perspectives in HIV Infection",subtitle:null,isOpenForSubmission:!1,hash:"1bcacf84d50370cac414fea1616244c6",slug:"current-perspectives-in-hiv-infection",bookSignature:"Shailendra K. Saxena",coverURL:"https://cdn.intechopen.com/books/images_new/3311.jpg",editedByType:"Edited by",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3841",title:"Trends in Infectious Diseases",subtitle:null,isOpenForSubmission:!1,hash:"a4d4dbcefd4b2122e63458bbfb544f82",slug:"trends-in-infectious-diseases",bookSignature:"Shailendra K. 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Causes are thought to be formation of scar tissue in the growth centers of the maxilla [4], mouth breathing due to obstruction of the nasal passage [5], deficiency of the alveolar process due to missing teeth [6], and a tense upper lip [7, 8]. Unrepaired bone defects on the other hand result in closer to normal maxillo-facial development [7, 8]. Because of midfacial deficiency, orthognathic surgery becomes often indispensable at the adult ages in CLP management. Treatment of CLP with orthognathic surgery involves maxillary advancement, distraction osteogenesis, and mandibular setback, combined with orthodontic treatment [9].
\nIn the past, CLP-orthognathic surgery in the mixed dentition period has been discussed and discarded. It has been reported that there will usually be a need for revisions after completion of skeletal growth [10]. Risks of early orthognathic surgery include damage to permanent tooth germs and creation of fibrous tissue and calli in the osteotomy regions. Additionally, it was shown that neither Le Fort I osteotomy nor distraction osteogenesis in the mixed dentition period provides additional lateral maxillary growth [11, 12]. Apart from cases with significant psychosocial or functional problems, risks of “early” surgery overweigh its benefits [13].
\nOrthognathic surgery for treatment of maxillomandibular deformities is usually applied after completion of growth of the maxillomandibular structure [14, 15, 16]. Transverse, sagittal, and vertical growth of the maxilla and the mandible ends at different chronological ages, usually at the ages of 14–16 for female patients and 16–18 for male patients [17]. Mandibular growth has a normal pattern in most CLP patients [13]. However, since skeletal growth is variable, hand-wrist or cephalometric radiographs may help in determining the timing of skeletal maturation [17].
\nIn orthognathic surgery in cleft patients, there are some issues that need to be considered before surgery like velopharyngeal situation, speech problems, hearing problems, the situation of alveolar cleft gap, and dental problems.
\nSpeech pathologists play a critical role in terms of assessing speech and articulation problems and determine velopharyngeal function with nasal endoscopy before the surgery [18, 19]. The velopharyngeal sufficiency rarely remains the same after maxillary advancement surgery; more often, an insufficiency is created [20]. Surgical correction of cross-bites and open-bites and the repair of cleft-dental gaps and residual oronasal fistulae usually alleviate articulation disorders [19, 21].
\nPrevention and treatment of tympanic infection as well as comprehensive preventive and restorative dental care have been provided during early childhood and adolescence. Oral hygiene maintenance may be more difficult in CLP patients than in routine orthodontic treatment patients. Soft tissues may have a more retentive morphology due to scarring from previous operations: shallow buccal sulci, sometimes buccal flaps with mucosa or gingivae covering teeth. Furthermore, because of poor dental esthetics, CLP patients do not like their teeth and smile and have low motivation. Long treatment times reduce motivation further. Orthodontic preparation presents various challenges not only in terms of planning but also in terms of implementation. It may be difficult for the orthodontist to work in a narrow space with low visibility, since the elasticity of lips is low, mouth opening is limited, and the upper jaw is small and retrognathic. All surgical management of maxillo-mandibular deformities usually requires prior adjustment of the dental arches over the maxillary and mandibular basal bones via orthodontic treatment. The “surgery-first” protocol rarely applies to CLP patients. A major dilemma during alignment is the decision on the management of the cleft alveolar region, where often the lateral teeth are missing [6]. Surgical correction of septal and inferior respiratory pathologies is done only in severe obstructive sleep apnoea cases before orthognathic surgery, but rather scheduled to be performed simultaneously or consecutively [22, 23, 24].
\nIn most CLP cases, teeth are either missing, erupt late or ectopically located. Therefore, the alveolar bone base is not sufficiently developed, and this adds to the skeletal (transverse and sagittal) insufficiency. Leveling of teeth erupting in the palate usually takes a long time (\nFigure 1\n).
\nTeeth erupting from the palate [25]. (a) UCLP patient, permanent dentition. Missing lateral incisors, 15 and 23 erupting palatally, and 17 erupting excessively buccally. (b) Dental arch development through orthodontic leveling, occult fistula enlarged and became visible during dental leveling, 13 is just starting to erupt after 2.5 years of orthodontic treatment.
Patients with Isolated Cleft Palate (ICP) have a complete alveolar ridge and generally a complete set of teeth [13, 17, 26, 27]. The main deformity in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients is maxillary hypoplasia, but oronasal fistula, bony defects, intranasal obstruction, soft tissue scarring, and velopharyngeal dysfunctions are also frequently encountered [27]. Additionally, the maxillary lateral incisor and often the second premolars in the cleft region are either congenitally missing, resulting in a cleft-dental gap [6, 28, 29, 30].
\nIn addition to the existing deformities in UCLP and BCLP patients, nasal obstruction and sinus blockage and mandibular asymmetry and chin dysplasia are seen frequently as secondary deformities [27, 31]. The prevalence of these deformities varies significantly based on the surgical philosophy and experience of the surgeon who repaired the first cleft [32], the individual’s unique biological growth potential, and the level of care of the family/patient.
\nPublished clinical research on individuals who were born with complete UCLP/BCLP and treated at cleft centers showed that, despite the best efforts, the mixed dentition period would not be appropriate for grafting just before the canine tooth is erupted on the cleft side in some children [33, 34]. Additionally, although grafted appropriately, in some individuals, additional reconstruction is needed [33]. For these reasons, repairing residual skeletal and soft tissues and managing dental deformities in patients with CLP strains the proficiency and skills of the orthognathic surgery cleft team [26, 31, 35].
\nStudies have examined the need for orthognathic surgery in UCLP patients who underwent primary lip-palate repair procedures in childhood [3, 8, 36, 37]. Ross [37] stated that the midface is close to normal only in 25% of patients, and there is a need for orthognathic surgery in the remaining patients, with interventions at early stages worsening the situation. In other similar studies, the rate of orthognathic surgery needed in repaired UCLP patients was 48–59.3% [3, 8].
\nIn adolescent or adult UCLP patients with maxillary hypoplasia and deficient bone grafts, there are two maxillary segments separated by the cleft. Each segment has varying degrees of dysplasia on the sagittal, vertical, and horizontal directions. Orthodontic treatment is carried out to both position the teeth perpendicular to the alveolar crest and level the alveolar segments using the teeth. Sometimes, it is not possible to achieve leveling of the bony segments, and it may be necessary to level the teeth into two separate segments, instead of a complete arch, and to prepare for leveling these segments by alveolar distraction osteogenesis or segmental orthognathic surgery (\nFigure 2\n).
\nUCLP patient [25]. A1-3: Before orthodontic preparation. Retrognathic and narrow maxilla, missing teeth (12, 22, 15 and 25), noticeable alveolar cleft, severe transverse and vertical dislocation of the smaller segment. B1-3: Orthodontic leveling of teeth in two separate segments. C1-3: Post-op continuous stainless-steel arch-wires. D1-3: Post-treatment vertical relapse to some extent.
In cases that present with sufficient bone grafting during the mixed dentition period, the maxilla is a single segment, and the orthodontist would only adapt the dental arch form to the existing basal bone.
\nThere are substantial variations in the number of upper permanent incisors and the alveolar bone amount in the premaxilla of UCLP patients. The lateral incisor tooth on the cleft side was found normal in only 7% of UCLP cases [6], more frequently, when present, there are shape anomalies. In the presence of a weakly formed lateral incisor tooth, these teeth might need extraction for long-term functioning and better esthetics.
\nDecision to extract the first premolar, which is another tooth near the cleft, is dependent on volume and height of the alveolar bone to accommodate the root of the canine adjacent to the cleft without irreversibly weakening its periodontal support, as well as the degree of crowding. Although extractions on the mandibular arch are sometimes obligatory due to crowding, extraction is usually not necessary in the mandibular arch. The disadvantage of closing a cleft-dental gap orthodontically or surgically is the shifting of the cleft segment toward the posterior, in a way that is the opposite of what is desired (to shifting forward of the posterior region).
\nAs mentioned above, after leveling and aligning teeth with orthodontic treatment, models prepared by digitally or by using plaster are transferred to computer software/articulators. On these models, the maxillomandibular relation and occlusion are adjusted to an ideal position, and the advancement of the maxilla, rotation/setback of the mandible and vertical and transversal dimension amounts are assessed. As a result of these arrangements, splints are fabricated to use as a guide in orthognathic surgery, and the desired effects almost completely reflected on the surgery.
\nDue to the prevalence of maxillary osteotomy complications in UCLP patients [38], confusing and complicated orthognathic surgery techniques were proposed for these patients [39, 40, 41]. Moreover, as in other aspects of orthognathic surgery, Hugo Obwegeser also provided contributions that could be explained as breakthroughs for skeletally cleft reconstruction [35, 42, 43, 44]. Toward the end of 1960s, he managed to advance the cleft maxilla by up to 20 mm to a desired position without needing a complicated mandibular setback approach. Then, he noticed that down-fracture and adequate mobilization of the maxilla, regardless of the presence or absence of a cleft, were the key in maxillary advancement [35]. The success of this approach achieved by Obwegeser was confirmed when Bell showed supply blood circulation to the down-fractured maxillae in their animal studies [45].
\nIn the mid-1980s, Posnick used the Le Fort I techniques of Obwegeser for treatment of UCLP deformity and improved them [46]. The main issue was that the circumvestibular incision used by Obwegeser directly allowed dissection, osteotomies, disimpaction, fistula closure, septoplasty, inferior turbinate reduction, pyriform aperture recontouring, bone grafting, and application of plate and screw fixation. This was a reliable approach that did not have a circulation damage risk in smaller or larger flaps and had continuity [35]. Moreover, with the easiness of field of view provided by circumvestibular incision, it became possible to readily close the cleft-dental region by differential maxillary segmental repositioning without bone necrosis or loss of teeth. This method also closes the unoccupied space of the cleft, and at the same time, combines the labial and palatal flaps together without needing a subperiosteal undermining procedure, which allows closure of stubborn oronasal fistulae and establishment of periodontal health in the teeth adjacent to the cleft [35]. Today, although the surgical methods applied on UCLP patients differ depending on the success of grafting performed in the mixed dentition period, the main method are as follows:
\nAn adolescent or adult CLP patient who has maxillary deformity but no residual fistula, in addition to an intact alveolar ridge with an adequate height in the cleft region may have been born without an alveolar cleft or had a successful grafting procedure [42]. A standard Le Fort I osteotomy may be applied on individuals who have sufficient alveolar ridge height and volume, a close palate and sufficient periodontal support. Segmental maxillary osteotomy may also be needed in correction of arch width, repairing vertical dimensions or preventing the need for prosthetic lateral incisors by closing the cleft-dental gap.
\nUnfortunately, even in the twenty-first century, alveolar defects and oronasal fistulae are encountered in many adults and adolescents who have UCLP with maxillary hypoplasia. For these patients, a modified Le Fort I osteotomy should be considered [17].
\nIn UCLP patients, the gap of the missing lateral incisor tooth may be eliminated by advancement of the lateral alveolar bone segment, where the canine tooth is placed adjacent to the central incisor tooth. After this, the canine is formed in a similar appearance to that of the lateral incisor [47]. This method that was described by Obwegeser in cases of unilateral cleft was advanced by Posnick in 1992 and name as the modified Le Fort I osteotomy method [46].
\nIn the technique, first, a maxillary circumvestibular incision is made labially from a zygomatic buttress to another. In the residual oronasal fistula region, vertical incisions are made to separate the mucosa on both sides of the cleft as oral and nasal. These incisions are perpendicular to the horizontal vestibular incision, and they follow the line angles of the teeth adjacent to the cleft (central and canine). If the cleft bone was not previously repaired, the segments are already in two pieces with the down-fractured maxilla. If the maxilla is intact and the arch form needs to be adjusted, by using a reciprocating saw with a short and flat tip, the maxilla is divided into two pieces by cutting from the cleft area. The parts need to be brought closer to close the cleft-dental gap. However, this may be achieved only after shaving in the distal direction of the central incisor and along the mesial part of the canine from the alveola. Attention should be paid to ensure avoiding contact with the lamina dura as it would expose the root of teeth and may result in external root resorption. The maxillary segments are then stabilized with wires and acrylic occlusal splints. Repositioning of the segments closes the cleft-dental gap, gathers the alveolar ridges together, and gets the labial and palatal mucosal tissues closer for oral-fistula closure [17].
\nThe extent of the maxillary advancement that is carried out by the surgeon is based on previously planned occlusion, airway needs, and preoperatively determined facial esthetics. The ideal vertical dimension is achieved based on the preoperative plan, but intraoperative approaches may be considered in some cases [35]. Maxillary osteotomy regions are fixed on all zygomatic buttresses and apertures by using titanium plates and screws based on the principles described by Luhr [48, 49]. If a graft has been used, an extra microplate is additionally applied to stabilize each interpositional cortico-cancellous (iliac) graft. For repairing facial asymmetries and secondary deformities, mandibular and jaw osteotomies are also frequently required in UCLP patients in addition to Le Fort I osteotomy.
\nIn the study that was carried out at Boston Pediatrics Hospital, it was stated that there was a need for maxillary advancement by orthognathic surgery in 76.5% adolescents whose BCLP had been repaired [3]. Moreover, the authors explained that, in addition to the severity of the cleft type, the number of previous operations and extent of cleft area also affect the need for orthognathic surgery. Another study conducted at Toronto Pediatrics Hospital stated that there was a need for orthognathic surgery in 65.1% of their own BCLP patients, while this rate was 70% for patients who were referred by other centers [8]. From the Cleft Craniofacial Unit in Adelaide, Australia, David et al. [50] followed BCLP patient groups from birth to adulthood and determined the need for orthognathic surgery. Accordingly, orthognathic repair was needed in skeletal class III malocclusion among 17 of 19 patients (89.5%) and when they reached 18 years of age. Other previous studies also supported the findings of the aforementioned ones [51, 52].
\nDifferent degrees of dysplasia in the sagittal, vertical, and horizontal directions are observed on the maxilla of patients without an ideal bone graft in the mixed dentition period that is divided into three segments. Before surgical treatment of maxillary segments, each segment is separately treated by an orthodontist. Before orthodontic treatment, cephalometric and panoramic radiography images are taken, and the angles, positions, and morphologies of teeth to soft tissues and bones are examined. In these patients, the volumes of the bones in the cleft region and the detailed position of teeth may be analyzed by additionally taking cone beam computerized tomography (CBCT) images.
\nBCLP patients have a broad variation in terms of the amount of dentoalveolar bone and the number of permanent teeth. Teeth that resemble lateral incisors are usually observed along the sides of the lateral segments. Due to the usually underdeveloped root structure of these teeth and their deformed crowns, extracting them is reasonable. Because of the deformed crowns and root structures of also the erupted supernumerary teeth found in the premaxilla of BCLP patients, it is usually appropriate to extract these during orthodontic treatment. In addition to this, only 7% of BCLP patients have lateral teeth with regular structure [6], and these are kept in the arch and moved to ideal position by the orthodontist.
\nDecision to extract the premolar teeth is dependent on the width and height of the present alveolar bone, position of canines, and the degree of crowding on the segments. In cases where inadequate bone and periodontal support remains or this support is substantially weakened after leveling and aligning the canines adjacent to the cleft, decision to extract of premolar teeth may be taken by the orthodontist. Aligning and leveling of the second molar teeth in addition to other maxillary teeth will increase the success of orthognathic surgery by improving the arch form and occlusion [35]. While extractions in the mandibular arch may be required based on the need for space on the arch and during the process of moving the incisors to an ideal angle, extraction is usually not necessary on the mandibular arch.
\nIncomplete, insufficient definitions were presented by previous studies for surgical techniques used for the purpose of warning BCLP patients about possible complications regarding maxillary osteotomy and achieving reliable osteotomy operations [39, 53]. Hugo Obwegeser provided significant contributions which may be considered as milestones about cleft surgery on BCLP patients. However, at the early stages, very few clinicians adopted the methods of Obwegeser. This was because, as one of the eight patients he treated died of airway complications, and the results on the others were not reported in an appropriate manner, relevant studies criticized them [54]. In the mid-1980s, Posnick described a safe method of the segmental Le Fort I osteotomy technique that considers biological principles in BCLP patients with maxillomandibular deformities [17, 55, 56]. This method, for instance, emphasizes preservation of the labial soft tissue mucosal pedicle in the maxillary of patients. The significance of this flap circulation that is achieved by considering biological principles was confirmed in the study by Bell et al. that was carried out on Rhesus monkeys [38].
\nMainly, in BCLP patients, clinicians encounter maxillary deformities including those that are intact on both sides (successfully grafted) with one alveolar ridge, those with two segments with one side intact (successfully grafted), and those with three segments that are failed/non-grafted, and they apply different orthognathic surgery methods for these.
\nPatients in cases of BCLP may have intact alveolar ridges on both sides, one intact alveolar ridge on only one side or alveolar clefts that have been successfully grafted during mixed dentition. In adolescents or adults with maxillomandibular deformity and intact alveolar ridges on both sides, a standard Le Fort I down-fracturing technique performs to advance maxillary hypoplasia.
\nIn an individual with BCLP, a unilaterally intact alveolar ridge (with residual alveolar cleft and oronasal fistula on the other side) shows the same anatomy as those in a UCLP patient. The surgical approach for such a patient is the same as that which is applied for a UCLP patient with separated segments. For patients who are born with BCLP and non-grafted alveolar arches, the modified Le Fort I Osteotomy (three-segment) procedure should be applied.
\nUnfortunately, a big part of patients who have BCLP maxillomandibular deformities are still observed to have alveolar clefts, residual oronasal fistulae, and mobile premaxilla. While carrying out a Le Fort I osteotomy procedure on a BCLP patient with non-grafted alveolar arches, accurate incisions has a critical importance for providing all three segments with blood circulation [17].
\nIn the technique, on each side, a buccal (labiolateral) incision is made from the zygomatic buttresses (anterior and gingival levels of the parotid canal) in the depth of the vestibule extending toward the location of the residual oronasal fistula. Then, vertical incision continues according to mesial angle of the canine (or if the canine is missing, the most mesial tooth on each lateral segment). Without completely separating the premaxilla, an intermediate splint is placed to fix the lateral segments. The premaxilla is to be included to the vestibular incisions at the posterior with angular, vertical incisions in its labial direction, and to separate the oral and nasal mucosa of the fistulae even further, the incision continues downward along the distal line angle of the central incisor teeth on both sides. Attention should be paid to prevent deformation or incision of the mucosa in the premaxilla. Shavings are made from the segments to get the hard and soft tissues closer to each other. While doing this, one should be careful not to damage the lamina dura of the existing teeth. After completion of the premaxillary segment and other adjustments, the final splint is placed, and the segments are fixed with titanium plates and screws [17]. If there is grafting, an additional microplate is also needed to stabilize each cortico-cancellous (iliac) graft. To repair facial asymmetries, mandibular deformations, and secondary deformities, mandibular surgery may also be needed in addition to Le Fort I osteotomy in BCLP patients.
\nIt was reported that 20% of Caucasians with ICP who receive repairs in the period of infancy would experience maxillary hypoplasia in a way that would lead to malocclusions that do not respond to a conventional or compensatory orthodontic approach by itself [36]. Chen et al. [57] reported on the horizontal maxillary growth of both children and adults with ethnic origins of Eastern China who were operated/not operated. Accordingly, as an interesting finding, the results of the individuals with ICP who were not operated in the mixed dentition period showed an almost normal horizontal growth. In the patients who were operated (repaired cleft palate) in the mixed dentition period, there was a decrease in the clockwise rotation of the maxillomandibular complex. In addition to this, it was stated that, for an individual born with ICP, the prevalence of maxillomandibular deficiency is dependent on a combination of factors such as the internal structure of the primary cleft defect, secondary hypoplasia due to surgical repair at infancy, and functional factors (e.g., muscle effects – mastication, respiratory pattern, and mandibular resting posture) [58].
\nThe main purpose of orthodontic treatment before surgery in ICP patients is to eliminate all existing dental compensations. This is because, conducting camouflage treatment in these patients threatens periodontal health and may cause to relapse and resorption in teeth. Inclination and angulation of the maxillary and mandibular teeth, crowding, gaps, and rotations are organized throughout the orthodontic treatment process. The targets related to achieving ideal arch forms and ideal occlusion may be detailed after the operation. Extractions may be needed in the maxillary arch to eliminate dental compensations. In comparison to UCLP or BCLP patients, treatment is simpler in ICP patients due to the intact nature of the alveolar bone and because all teeth are usually present.
\nIn general, primary maxillomandibular deformity that is seen in ICP patients is maxillary hypoplasia that is caused by the cleft deformity and surgical interventions. The normal reconstructive procedure that needs to be considered in these patients is a Le Fort I maxillary osteotomy. Obwegeser stated that complete mobilization of maxilla that are down fractured is needed to achieve an orthognathic repair during surgery and decrease skeletal relapse [35]. Bell and Levy [45] confirmed that the Obwegeser Le Fort I technique allows sufficient blood diffusion for satisfactory bone recovery without aseptic necrosis or tooth injury.
\nIt would be difficult to close any residual palatal oronasal fistula in an ICP patient at the same time with the Le Fort I procedure during orthognathic surgery. The reason for this is that elevation of the palatal flaps that is usually needed will threaten the blood supply for the down-fractured maxilla. Moreover, it was stated that, if an impermeable closure of the nasal side can be achieved following down-fracturing before fixing the maxilla to its new position, the residual mucosal gap on the palatal side will usually be recovered secondarily by fistula closure [35].
\nManagement of the process at the hospital and at home during the initial recovery process of the orthognathic patient is highly important for a successful outcome. Cephalometric and dental radiographies and facial and occlusal photographs should be taken at certain intervals after the surgery in order to documentation and check the patient’s recovery [17].
\nOrthodontist should remove the splint and see the patient in the next 24 hours to replace the maxillary segmental arch wires or rigid continuous arch wires. The maxillary teeth are tied to each other to preserve the occlusion, sagittal advancement, and transversal dimension. After 2 months of surgery, active orthodontic treatment and finishing procedures can be continued. A trans-palatal appliance (wire or palatal appliance) is recommended to stabilize the new arch form. The orthodontist should closely monitor the patients throughout the 6 months following the surgery to follow up on skeletal and dental relapse and to maintain orthodontic treatment [17].
\nIn routine and unproblematic cases, splint usage is abandoned in about 5–7 after the surgery. However, in patients with early skeletal relapse, that is, within the first 2–8 weeks, the teeth are forced in the buccolingual direction toward outside of the bone because the teeth are held in place due to splint despite the alveolar relapse, and severe gingival recessions may occur (\nFigure 3\n). Therefore, CLP patients should be observed every week, unlike other orthognathic surgical patients. It should be kept in mind that the relapse rates given in the literature are averages, and it is possible to see more of these amounts in individual cases.
\nPeriodontal tissue loss due to relapse [25]. (a) Initial: Patient with UCLP, maxillary hypoplasia, severe crowding, missing lateral, and asymmetric arch form. (b) Pre-op: Periodontal problems after expansion and leveling. (c) Post-op: Both transverse and sagittal skeletal relapse occur while teeth are locked within the arch-wire and surgical splint, which deteriorates the periodontal condition. The midline was surgically corrected.
Speech may be objectively assessed in 3–6 months after the surgery. A nasal endoscopy may be used for this. Exact cleft-soft tissue procedures (e.g., cleft rhinoplasty, revision of the labial scar, pharyngeal flap or flap revision) may be carried out in 6 months after the operation. After removal of orthodontic appliances, pre-planned restorative approaches may be implemented [17].
\nAfter orthognathic surgery, cleft patients have a higher than normal risk of relapse due to factors such as different soft tissue-bone relations and complex mobilization vectors. Fahradyan et al. [59] reported that, in comparison to class III malocclusion patients without clefts, more relapse was encountered in those with clefts (1.25 mm or more on average), and there was a significant positive correlation between larger clefts and horizontal relapse. In their study, the mean relapse rate was similar among different types of clefts, and in the case of each 1 mm increase in maxillary advancement, horizontal relapse increased by 0.3 mm on average [59].
\nRichardson et al. [60] examined all relapse cases among individuals where more than 11 mm of maxillary advancement was applied, and they reported a horizontal relapse rate of 18.75%. Nevertheless, Bhatia et al. [61] concluded that relapse rates stayed the same even in maxillary advancement degrees of more than 15 mm (mostly in cleft patients). Yamaguchi et al. [62] reported in their systematic review that the mean values of horizontal and vertical relapse were, respectively, 17.9% and 35.4% in orthodontic surgery for cleft patients. This shows us that vertical stability is lower.
\nAlthough most studies focused on horizontal maxillary stability, Park et al. [63] reported that postoperative mandibular relapse in cleft patients had a strong positive correlation with mandibular clockwise rotation and setback amounts. Wong et al. [64] could not find a significant difference between the relapse rates of individuals who received two surgical operations and those who received maxillary advancement surgery only. Some researchers used bone grafts to increase horizontal or vertical stability [61, 63, 64]. It was reported that usage of grafts has a preventive effect on horizontal maxillary stability with an average of 1.72 mm less relapse [61].
\nTreatment of cleft patients with class III malocclusion that results out of the combination of maxillary hypoplasia and intermaxillary disorder is usually achieved by maxillary advancement, mandibular setback, and clockwise rotation of the maxillomandibular complex. While maxillary advancement is associated with increased upper airway cavity, in contrast, mandibular setback is associated with reduction of airways with outcomes such as postoperative airway blockage, snoring, hypopnea (slow respiration), and obstructive sleep apnoea [65, 66]. Additionally, a pharyngeal flap may contribute to the airway-related difficulties that are encountered during operation or in the postoperative period. When the three-dimensional (3D) pharyngeal airway cavity of cleft patients in their pre- or post-pubertal periods were compared to a control group, Karia et al. [66] found significantly smaller airway sizes in the cleft group. The total airway volume increased from the pre-pubertal to the post-pubertal periods in both groups, but the reason for this outcome in the cleft group was not anteroposterior growth as in the case of the control group, but in contrast, associated with vertical airway growth. Especially in bilateral cleft patients, significantly reduced pharyngeal airway cavity in comparison to individuals without clefts was also confirmed in a CBCT study [67].
\nA prospective study by Chang et al. [68] examined the airway changes in cleft patients who received maxillary advancement and mandibular setback treatments by not only CBCT but also polysomnographic examination. Regarding the airway changes after orthognathic surgery, it was found that there was no significant difference in sleep-related respiratory functions, but the snoring index was improved.
\nIt is believed that maxillary advancement in cleft patients has a potential to worsen velopharyngeal function (VPF). Nevertheless, there is still no certain evidence on whether or not the amount of advancement affects velopharyngeal disorder and whether or not preoperative VPF is related to the postoperative outcome. It is most likely that improvements are seen in the articulation of patients after surgery due to the correction of dental arches [69]. In a systematic review of the complications that developed as a result of orthognathic surgery on cleft patients, Yamaguchi et al. [62] reported postoperative velopharyngeal deficiency (VPD) as 16.79%.
\nMoran et al. [70] examined 79 cleft patients who received treatments of conventional orthognathic surgery or distraction osteogenesis, and they reported that, following maxillary advancement rates from 3 to 11 mm, there was VPD in 5 (6.33%) cases. These five patients were also found to have borderline VPD preoperatively. The results of their study supported those of other studies that there is no relationship between maxillary advancement and the amount of postoperative velopharyngeal disorders [71], and when orthognathic surgery and total maxillary distraction are compared in terms of speech and VPD, there is no significant difference [71, 72, 73]. Additionally, the finding that there is no correlation between postoperative speech impediment and preoperative borderline VPD was added to the literature which reported similar findings [71, 72, 73].
\nIt is a difficult process to estimate soft tissue changes after orthognathic surgery and prevent them. This is because the adaptation of the velopharyngeal region for compensation of other regions is variable, and it is dependent on the personal characteristics of each patient and the capacity of tissues that are present or transplanted to become functional [74].
\nInfection rates following orthognathic surgery are highly variable due to reasons such as antibiotics usage styles and diagnostic differences [75, 76]. Recent studies on orthognathic surgery in individuals without clefts reported an incidence of less than 1–8% [76, 77, 78].
\nMiloro derived a few results by analyzing 15 previous studies on infections following orthognathic surgery: infection incidence may decrease in the case of using oral antibiotics for more than 1 day after surgery. First-generation cephalosporins are used more frequently before surgery. Mandibular osteotomy regions are where infections are seen the most. Extraction of the third molar may have a small effect on infection incidence, but this is under debate. Most infections that occur after orthognathic surgery are small, and removal of fixation plates and screws is rarely necessary [75].
\nIn an analysis of the USA National Inpatient Samples Database (2012–2013), the rate of emergence for any kind of infectious complication following orthognathic surgery was reported as 7.4% in patients with a craniofacial anomaly and 0.6% in those without a craniofacial anomaly [78]. Recent studies reported rates of from 0to 13.92% for infections emerging after orthognathic surgery in cleft patients without any craniofacial anomaly [61, 62, 68, 70]. In the study that obtained a high rate of incidence as 13.92% despite 5 days of routine antibiotics usage, the authors emphasized the importance of oral hygiene, team collaboration, and patient cooperation [70].
\nSegmental maxillary osteotomies may have a risk of postoperative oronasal fistulae. In a systematic review in 2017, the postoperative fistula rate was reported as 19.3% in segmental Le Fort I osteotomy [79]. While residual oronasal fistulae in cleft patients increase the difficult of orthognathic surgery, they may be repaired by adjusting the incision patterns during surgery. In addition to this, according to the systematic review in 2016 by Yamaguchi et al. [62], the closure deficiency of a pre-existing fistulae (28.57% for palatal, 10.74% for alveolar fistulae) was the most frequently encountered complication. Another study reported a residual fistulae rate of 10.53% [70]. Nevertheless, residual fistulae rates may be reduced by careful dissection, unstressed closure, delicate tissue management, and compliance with blood circulation [80].
\nThe neural disorders that occur as a result of orthognathic surgery mainly affect the infraorbital, inferior alveolar (mandibular), and mental and incisive nerves. Reports on facial nerve paralysis vary in the range of 0.17–0.75% [81].
\nThe incidence of continuation of inferior alveolar nerve disorders varies between 5 and 15% depending on the age of the patient and the technique that is used (piezo-surgery or conventional) [82, 83]. A systematic review in 2017 reported that usage of piezo-surgery in orthognathic operations was associated with significant reductions of loss of blood during surgery and severe nervous disorders [84].
\nIn orthognathic surgery on cleft patients, 70% of the patients may experience paresthesia after surgery, and a permanent sensory disorder may occur in 25% [80]. Bhatia et al. [61] stated that all 25% of patients who experienced cheek paresthesia recovered after a year. Moran et al. [70] reported that the sensory neuropathy of the infraorbital nerve was temporary in 53% of patients and permanent in 1.27%. In addition to this, 3D computer-assisted planning and determination of the inferior alveolar nerve may contribute to the safety of orthognathic surgery [85].
\nOrthognathic surgery, which is the last stage of CLP treatment, is a highly important step in management of the entire process. Therefore, there should be good communication among the patient, the family, and the cleft team. There are effects of factors that are unique to individuals or clefts on the outcomes of surgery, but their extent is still under debate.
\nDespite the different rates reported in the literature, the rates of complications in cleft surgery are striking. Strategies should be created by focusing on causes and mechanisms to prevent or minimize these complications.
\nRice (Oryza sativa L.) is one of the most important crop in the world in terms of total developing world production (480 x 106 tonnes of rough rice in 2012) and the number of consumers (3.5 billion) dependent on it as their staple food and is cultivated in over 100 countries in every continent (except Antarctica), from 53oN to 40oS and from the sea level to an altitude of 3 kilometres high [1]. In 2019, the total world rice production amounted to approximately 738.75 million metric tons (MMT) from total harvested area of approximately 162.71 million ha, making rice the world’s third most-produced cereal crop after maize (1.12 billion metric tons) and wheat (731.45 MMT) [2]. On the African continent, especially in sub-Saharan Africa (SSA), rice has become a staple food crop and constitutes major part of the human diet [3]. Over the last three decades, African countries has experienced a consistent increase in rice production and consumption demand making rice the fastest growing staple food especially among low income earners [4]. In countries such Tanzania, Niger and Nigeria transformational changes in the production practices and shift of consumer preference from other coarse grain such as corn, sorghum and millet towards rice is particularly glaring and fuelling increased local production and consumption demand. Available statistics indicated that Africa produce an estimated 20.5 million tonnes of paddy rice annually [5], and West Africa is the continent’s rice powerhouse, producing about 66% of the total paddy in Africa, mostly by smallholder farmers [4].
The growth in rice production, processing and consumption in many Africa countries has been shown to have direct correlation with growing income, rapid urbanization, population growth, and change in the occupational structure of African families. It is believed that as more and more women and young girls in Africa join the workforce, and more men live and work in urban area, there is a shift toward food that is more convenient and cooks fast such as rice. Although the per capita consumption of rice is declining in many parts of Asia, in Africa, especially the SSA region, the demand for rice is increasing and at a faster rate than in any part of the world [6]. However, rice production in Africa has not kept pace with the increasing demand, resulting in huge volume of rice imported to fill the gap at a significantly high cost to Africa external reserves. Rice farmers in Africa, especially in Nigeria, Niger and Tanzania, have responded to the increasing demand for rice, as reflected in upward trends in total production in recent years [7]. But, when compared with population increases, the rice production trends are much less impressive and many of the countries are becoming increasingly dependent on rice imports, fuelled by growing production-to-consumption gaps [8].
Geographically, according to International Rice Research Institute (IRRI), Africa has the highest reserves of untapped natural resources for food production globally, especially water and land (130 million ha of inland valley) which are essential for rice production [5]. In spite of these sizeable land and favourable agro-ecological conditions, the Food and Agriculture Organization [7] and The World Bank, [9] states that significant number of population are undernourished while poverty and unemployment levels in country such as Nigeria is significantly high (69%). Added to the high level of unemployment, food insecurity and under nutrition, there is huge food losses and waste along the entire food value chain. It has therefore become imperative to make concerted efforts to reduce losses especially postharvest losses to improve food and nutrition security in Africa [10]. Huge volume of rice produced in Africa for instant like in most developing countries does not reach the table of the final consumers due to significant post-harvest losses in terms of physical grain loss (PGL) and grain quality loss (GQL) [11].
Research for development (R4D) in Africa have developed technologies and innovations and made recommendations for increasing rice productivity through the use of high yielding varieties, expansion of area under cultivation and reducing postharvest losses through good production practices and adoption of improved technologies [10, 11]. However, in most African countries, where tropical weather and poorly developed infrastructure contribute to the problem of food loss, wastage can regularly be as high as 40–50% and has been one of the key encumbrances to farmers’ income and sustainable food security in this region [12, 13]. Postharvest losses have therefore contributed significantly to African’s inability to attain self-sufficiency in local food production and also a huge drain to local production and food security, as colossal quantities of food, including rice are lost, year after year [13]. Globally, Gustavsson et al., [14] noted that about 1.3 billion tons of food are wasted or lost annually, while in the local context such as Nigeria, the country’s agricultural productivity has been generally low, mostly due to post harvest losses of farm produce (20% for grains such as rice and over 40% for fruits and vegetables), and attributed these to poor post-harvest handling, inadequate agro-processing development among other critical factors.
The adoption of good agronomic practices, favourable government policies and shift in consumer preference from other staple coarse grains toward rice have fuelled increased production and yield per hectare of rice across Africa. However, postharvest losses that have been relatively small in absolute terms have increased proportionally with increased yield per ha. Therefore, integrated management of postharvest operations such as threshing, cleaning, drying, parboiling, milling, grading and branding and storage have now been adopted in many rice producing clusters to reduce losses at each stage of the chain [13].
Ndindeng et al, [11] observed that resolving the critical issues along the rice value chain in many SSA countries is also impeded by the lack of a simple, adoptable and well- defined practical methodology on how to estimate PGL and GQL after harvest. This makes it impossible to have credible data during the various operations along the rice value-chain. Secondly, there is also wide quality gap between imported milled rice and domestically processed rice. The locally processed rice in Africa including Nigeria tend to be of poor quality due to high level of impurities (stones, weed seeds, sand and insect residues), high level of broken fractions, variability in grain size and colour and off-flavour perceived when cooked. However, many cost effective and efficient postharvest handling machines and practices developed and recommended by R4D organizations are not available for farmers, probably due to poor extension and funding challenges. In postharvest operation such as parboiling, the use of rudimentary technologies has resulted in high losses estimated at 15–20% with high energy and water demand which contributes to the final cost of the final product and environmentally unsustainable practices because of dependent of wood fuel [10]. They recommended the valorisation of rice processing by products to enhance income for the rice value chain actors and also improve food security and sustainable environment.
Broken rice fractions, bran and husk are major by-products of rice processing operations. They account for about 25–50% by weight of milled rice depending on variety and technology of milling. In many rice producing communities in Africa, rice processing by-products such as husk and bran are generally dispose and dumped as hips of wastes in many rice processing sites with little or no environmentally friendly ways of disposal. This has resulted in dusk related health challenges for people living nearby and methane emission during its natural decomposition [15]. But research in many parts of the world including Africa has indicated that rice husk if properly harnessed can serve as good raw materials for fuel [16, 17] and low grade broken fractions could be used for the production of other value added products [10] that may increase farmer’s income, safe guide the environment and improve food and nutrition security. Broken rice fractions can be converted to high quality flour and used for the production of value added products that can enhance nutrition and food security and livelihood of smallholder farmers and profitability of small-scale food processing industries [18]. It can also employ huge number of youths and women and serve as sources of employment and reduce restiveness.
This chapter will cover selected innovative techniques and technology advancement made especially by the Africa-Wide Taskforce on Rice Processing and Value Addition and its partners in developing strategies for minimizing postharvest loss in Africa through the development of technologies for utilization of broken rice fractions and rice husk to reduce rice postharvest losses in Africa. Major challenges mitigating the adoption of this technologies and possible opportunities in the rice postharvest value chain that can attract investment for the improvement of rice production and reduction in rice postharvest losses are also outlined. This synthesis we believe will help in providing future direction for research and support for sustainable rice postharvest system in Africa.
Rice postharvest value chain is a set of unit operations in which well matured harvested paddy rice pass through from the point of harvest to consumption. Efficient and sustainable rice postharvest value chain therefore, aimed at minimizing losses and maximizes quality of the harvested grains until it reaches the consumer [10]. At each level of the value chain, several actors are involved and different values of losses are recorded. In Africa, especially in West Africa, several actors using diverse kinds of equipment and techniques are involved in primary, secondary and tertiary postharvest operations of the rice value chain (Figure 1).
Unit operations at different levels of rice postharvest system in Africa.
Losses particularly along the value chain [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18] has been highlighted as a major source of lost in revenue and productivity among value chain actors as both quantitative and qualitative losses occur during any of the stages [19]. This is an indication that critical attention need to be given to the postharvest value chain to reduce loss in productivity and make rice production a sustainable venture. Technically, when paddy is harvested, it passes through the first routes (A), before storage, but may also be traded directly by farmers to middle men or collected together by farmers’ cooperative groups where this exists before marketing at a favourable period. Currently in Africa, especially SSA, little or no value addition is carried out at the primary postharvest level. At the second level (B), some levels of value addition are made where the paddy is either milled after parboiling or directly after winnowing to produce white rice which is traded as milled rice and used for the preparation of traditional whole kernel rice-based foods [20]. At this point where appropriate technologies are used, grain quality is improved which translate into improved economic value and competitiveness of milled rice.
Over the last few years, in Nigeria and other African countries, several large scale integrated mills have been installed which combined parboiling and milling operations and coupled with grading and packaging system. In these mills, parboiling and drying energy are generated by combusting the husks, while milling uses electricity from national grid or private generators. Recently, a third level have been added to the chain, where low grade broken fractions, a by-product of rice milling is converted to rice flour and used for the production of diverse rice-based products (C) or other by-products such as husk are used for energy for artisanal rice parboiling and household cooking [16, 17, 21]. The tertiary postharvest level is built on broken rice, bran and husk utilization where low quality rice is converted into flour and used for the production of flour-based products, while bran is used in combination of legumes for the production of animal feeds and sold to animal husbandry firms and husk for energy sources. It is important to note that rice postharvest operations in SSA consist mainly of manual operations resulting in high crop losses and contamination.
Postharvest losses in food production including rice not only have effects on social and economic scales, but also represent a waste of resources used in production such as land, water, energy and other inputs. Report by Africa Postharvest Loss Information System [22] indicated that losses occurs hugely at all levels of the rice postharvest operations. Harvesting operations including harvesting, threshing, winnowing and drying resulted in an average of 11.2% loss due to grain spillage and poor threshing where grains are left on panicles. Transportation resulted in 2.3% (to farm and market) and storage 3.4% indicating an approximately 15.91% average postharvest loss across the continent. Report by Sallah, [23] on the postharvest losses of rice and its implication on livelihood and food security in Africa taking a case of Cameroon and The Gambia indicated that losses at threshing operation were 19 and 17%, drying 9.3 and 7.0%, storage 4.2 and 6.0%, milling 1.3 and 1.0% and transportation 1.33 and 0.8% respectively for Cameroon and The Gambia. This results in reduced income and employability of the people in the study area. Loss was aggravated by lack of or poor processing equipment, poor storage facilities, poor knowledge and skills on postharvest reduction strategies.
It has been estimated in Nigeria by Oguntade et al., [24] that rice post-harvest losses may be as high as 20 to 40%, implying conservatively between 10 and 40% of rice that grown in the country never reaches the market or consumers table or are traded at a discounted price due to loss of quality resulting from poor postharvest management. The high postharvest losses slowdown the marginal increase in rice production recorded over the last few years in many African countries and also threatened food and nutrition security. Because of the adoption of improved technology in rice production in developed countries, postharvest losses occur primarily at the consumer level, with minimal losses at the field or after harvesting or at the other stages of the value chain [10, 25]. In contrast, postharvest losses in Africa occur mainly during harvesting through to market stages, with slightest share of losses occurring at the consumption level [25, 26].
According to Oguntade et al. [24], huge losses totalling about 11.39% is recorded during rice postharvest level in Nigeria, with harvesting accounting for 4.43%, threshing and cleaning (4.97%), transporting paddy from field to homes (0.34%), paddy drying and storage (1.53%) and transporting of paddy to local markets (0.12%). At secondary postharvest levels (Figure 1), rice parboiling process, an essential pre-treatment given to paddy rice before milling accounted for 5.19% paddy loss, while milling at the village level and milled rice transportation, marketing and storage results in 4.40% and 7.54% losses respectively. Danbaba et al., [10] correlated the data with rice production statistics of 17.5 MMT of paddy produced in Nigeria in 2016 [27], considering postharvest losses of 11.39% paddy from harvest to market and 135 Naira per Kg market price of paddy (as at November, 2018), Nigeria losses about 1.99 MMT of paddy representing 269.09 billion naira annually. These losses are huge and unsustainable if added up to the estimated 123 billion naira losses during the parboiling and milling processes. Situations from the three African countries classically indicates the unfavourable postharvest loss situation on the continent which calls for urgent action and intervention.
The continues increase in rice consumption together with minimal increase in domestic production coupled with high postharvest losses, high rice import cost and glaring impacts of climate change and conflicts in Africa, research and development organizations are working together under a coordinated strategy lead by Africa Rice Centre (AfricaRice) to provide innovative approach for improving productivity and food and nutrition security through postharvest loss reduction. The rapid advances in small and intermediate technology development, formulation and production of new value added products from low grade broken rice fractions and other rice processing by-products demonstrated the ability to improve food and nutrition security in Africa through novel postharvest loss reduction strategies [10, 16, 21, 28]. Until recently, rice research for development has focused on yield improvement without much emphasis on postharvest practices especially as it relates to loss reduction, quality improvement and marketability. But Nguyen and Ferrero [29] opined that in near future, the possibility of expanding rice production area will remain limited in SSA due to high cost of developing new land suitable for rice production combined with water scarcity for rice production and urban and industrial expansion, implying that loss at any point of the value chain need to minimized to save food and nutrition security in SSA.
In 2008, the SSA countries were faced with significant hike in food price [30]. Milled rice in the international market grow by almost 400% and combined with about 40% rice deficit in SSA, it become highly vulnerable to global rice prize shock and probably was the major cause of ‘food riot’ in 2008 in countries such as Burkina Faso, Cameroon, Cote d’Ivoire, Mauritania and Senegal [31, 32]. The riot of 2007–2008 [32] triggered renewed focus and investments in rice production together with postharvest operations in many African countries. Nigeria, Ghana, Togo, Cote d’Ivoire, The Gambia, Senegal and Burkina Faso developed a national strategic plan to attain rice self-sufficiency in medium and long time by increasing public and private sector investment into rice sub-sector of their economy, but quality and postharvest losses are least emphasised [33]. In 2011, AfricaRice lead a consortium of research organizations in major rice producing countries of Africa to implement and innovative postharvest loss reduction model ‘enhancing food security in Africa through the improvement of rice postharvest handling, marketing and development of new rice-based products’. The project emphases the utilization of flour from low grade broken rice fractions to prepare value added food products such as snacks, biscuits, and porridges. This innovative uses of rice can catalyse rural enterprises and raise income, especially for women farmers and processors in Africa [33]. The project also developed innovative technology to utilize rice husk for energy as a strategy to add value to rice husks which are hitherto stockpiled and dumped near mills where they rot and produces methane (a potential greenhouse gas) or burned in the open fields, thus causing pollution.
By improving harvest and postharvest system of rice value chain in Africa, small holder farmer’s income will be enhanced through time saving on processing, reduction in qualitative and quantitative postharvest losses which will translate to higher income and better quality of locally milled rice which may compete favourably with imported brands and fetch better price, thereby enhancing the incomes of various actors along the value chain. New rice products containing high nutrients will improve nutrition security and provide employment for women and youths and the overall industrial development of rural communities. The utilization of rice husks for energy will certainly reduce deforestation which is currently threatening significant number of countries of Africa, especially the Sahel region.
Innovative production is a concept that describes an on-going re-engineering process with the major aims of evolving products and production engineering from prevalent trends based on advances in research for development [34]. Innovative rice postharvest loss reduction trends in Africa is being re-engineered by evolving new value added products based on prevalent research trends. Since production innovation strengthens the productivity and resource use efficiency of production system, recent trends in Africa in the field of rice postharvest system development is the innovative approach to the utilization of rice processing by-products as a strategy to strengthen the productivity of rice and resource use efficiency. The following sections describes the innovative strategies currently used in Africa to reduce postharvest through efficient postharvest system management.
Fissuring cause by poor postharvest handling of paddy results in broken kernels upon milling, and consequently lost in quality and economic values of milled rice [35]. However, recent increase in the use of rice flour has promoted interest in broken rice fractions utilization as raw materials in many foods especially snacks, porridges and others [36]. Rice flour has been used traditionally for the production of traditional stiff dough (tuwo) in Nigeria and many West African countries [20]. Its application in the production of high quality flour that could be used in baking has been hampered by lack of improved rice flour production process that produces flour of particles sizes that could be considered suitable as baking flour and improved functionality [21].
Chiang and Yeh [37] proposed wet milling of rice kernels to produce flour of desirable functionality. As a strategy to valorised broken rice fractions resulting from poor milling processes and rice of low grain quality characteristics, broken rice fractions are processed through wet milling process to produce high quality rice flour that has appreciably acceptable baking quality [21]. The innovative technique which is being commercialized in Africa, involves repeated wet grinding of soaked broken rice fractions and sieving through a fine cloth mesh until virtually all the slurries are made to pass through the sieve. The filtrate is allowed to stand for 3–4 hours depending on the variety and water temperature and decanted to obtain smooth sediment at the bottom. The solid sediment is broken into pieces and dried in an oven before pulverizing and sieving (200 μm) to obtain rice flour (Figure 2). The United States Code of Federal Regulation (CFR) state that for a product of milling of grains to be considered as flour, not less than 98% of the particles of the milling process must pass through a sieve having opening not larger than 212 μm [38]. Flour of this particle size characteristics has been demonstrated to impact positively on the end-use application [21, 38, 39, 40] studied the physicochemical and functional properties of flours from some common Nigerian rice varieties and concluded that these properties are promising for their application in food systems.
Flow chart for the production of high quality rice flour from broken rice fractions. Danbaba et al. [21].
Production of flour from broken rice fraction has been shown to improve the economic value of broken rice kernels by 38% and significant consumer preference for snacks and other baked products. This has significantly reduced qualitative losses incurred during rice processing and improved income of smallholder food processors. The high quality rice flour is also blended with legume based flour (Figure 3) to improve protein content and quality to enhance nutrition and product specifications [21] which is an innovative production system.
High quality rice flour from broken rice fractions (left), branded rice flour (centre) and rice flour blended with cowpea flour for the production of high protein baked products [21].
Recent changes in social life of many population across the world and the development of middle class worker in developing countries of Africa has resulted in high population of people who are inclined to eat ‘ready-to-eat’ food, because of its convenience, easy to consume, low to moderate price with minimal need for further processing. Extruded snacks are example of such products and their consumption is growing by day. Extrusion cooking technology is a continuous mixing, cooking and shaping process carried out at high temperatures over short times [41]. It is a very versatile, low-cost and highly energy efficient technology for snack or expanded foods production. Extrusion of cereal-based flours or other starchy raw materials is widely used in the food industry in developed countries to produce snack foods [42]. Little of extrusion cooking is being practiced in Africa especially as it relates to value added rice processing, but recent advances in rice postharvest science has introduce the use of low grade broken rice fractions as raw material for the production of extruded snack foods [10, 43].
However, when starchy raw materials such as rice are subjected to extrusion cooking, there is a chemical and structural transformation such as starch gelatinization, protein denaturation, complex formation between amylose, lipids and/or proteins, and degradation of pigments and vitamins [44]. Under the Africa-Wide Taskforce on Rice Processing and Value Addition of Africa Rice Centre and its national partners, low grade broken rice fractions from different milling operations have been tested and validated for the production of snacks that are high in protein and acceptable to consumers [21, 43]. Through process modelling and optimization, optimum moisture content, barrel temperature and level of legume flour for extrusion have been established for the blends of broken rice fractions with cowpea, bambara groundnut and soybean, keeping other extrusion parameters within range [21, 28, 43]. This optimized process conditions produces extruded snacks with smooth outer-surface (Figure 4) and uniform air spaces with regular shape, this according Ryu et al., [45] are features of good quality extrudates.
Photographic images (longitudinal section) of the physical state of rice-cowpea blend extruded snacks.
Because extrusion cooking process allows for the production of low-fat snacks and induces the formation of resistant starch, which makes no caloric contribution and behaves physiologically like dietary fibre [46], rice-based extruded snacks in Africa have received satisfactory acceptability among consumers that are concerned with nutritional quality of food they eat. As a result, therefore, the application of extrusion cooking is increasingly becoming popular for snack production in Africa using raw materials such as rice [28, 43], sorghum [47], and millet [48] containing protein, starch and dietary fibre in an effort to create novel food products such as snacks with a more adequate nutritional value. This new product is expected to improve rice postharvest system through qualitative loss reduction and improve overall food and nutrition security of the populace.
In some instance, it has been demonstrated that when crushed and pulverized, extruded broken rice fractions could be used as porridge or weaning foods. Danbaba et al [21, 28] introduced extruded ready-to-eat rice porridge (Figure 5) as part of valorisation of low quality broken rice fractions after blending with appropriate amount of legume flour. Protein-energy malnutrition (PEM) and micronutrient deficiency is a severe problem facing developing countries and particularly children under the age of 5 years. This has resulted in more than 50% of childhood death in developing countries including Africa [49, 50]. Blending cereals with legumes in the production of complementary foods has been shown to improve childhood nutrition and significantly reduce mortality [21, 28, 43]. Several authors including Stojceska et al., [51]; Obradović et al., [52]; Panak Balentić et al., [53, 54] have also shown in other parts of the world that it is possible to enrich extruded cereal-based snacks with nutritionally valuable ingredients such as protein from ingredients like legumes. The utilization and application of extrusion cooking in Africa provides an alternative for producing high protein-energy weaning porridges from the blends of low grade broken rice and legumes. This process according to Pathania, et al., [55] credible alternative from the traditional practices for the manufacturing of re-constitutable foods for blended flours (Figure 5). Extrusion cooking therefore is expected to impact positively on the rice postharvest system in Africa in the years to come.
Production of extruded high protein-energy weaning porridge from blends of broken rice and cowpea.
The increased demand by more consumers for gluten-free products has over the few decades necessitated the quest for suitable alternative raw materials to wheat for the production of third-generation snacks, and the use of rice flour is gaining greater interest because of its favourable attributes of negligible gluten content, good expansion during extrusion and bland taste [56]. Third-generation snacks (3G), also called semi or half products, during production undergo cooking after extrusion and are dried to a stable moisture content (approximately 12%) and then expanded by frying in hot oil, puffing in hot air or microwaving and infrared heating as new variants [57]. In developed world or where extrusion cooking technology has gained popularity, 3G snacks are common. After expansion products are spiced with various types of spices and then packaged and sold as ready-to-eat (RTE) snacks [57]. The products can also be flavoured before expansion and sold as pellets, for preparation at home [58]. In Nigeria, under a strategy to improve postharvest quality of rice, especially poor quality rice varieties having poor parboiling characteristics, kernels are converted to high quality flour of specific particle size and used innovatively for the production of 3G snacks (Figure 6) that are current popular among snack producers in many African countries [21].
Some rice-based 3G snacks produced from low grade broken rice flour.
Cold forming extrusion (40–70°C, 60–90 bar) of pre-gelatinized rice flour blended legume flour is used for the production of rice-based 3G snacks. Adjusting extrusion temperature, residence time and initial ingredient moisture facilitate complete gelatinization of starch component of the ingredients before frying [57, 59, 60]. Extruded snacks from rice will significantly take some market share as more and more countries in Africa are increasingly improving their rice production and more consumers are becoming more interested in non-gluten baked snacks. Badau et al. [61] state that the addition of 30% cowpea to rice flour for the production of traditional Nigeria snack (Garabia) significantly improves protein content, metabolizable energy and vitamin B2, while consumer rating based on 9-point hedonic scales was above 6.0 indicating that with the addition of cowpea, the snacks are well-liked by consumers.
In 2014, it was estimated that Sub-Saharan Africa produces about 22.1 million tonnes of paddy, which represent about 4.6% of the total global production [5]. Structurally, paddy consists of about 72% kernel, 5–8% bran and 20–22% husk [62]. Therefore, when 22.1 million tonnes of paddy are subjected to milling, it produces about 4.8 million tonnes of husk [11]. With the increased production of paddy in Africa over the last 2 decades, the annual production of rice husk has also proportionally increased. The utilization of rice husk for economic purposes hitherto in Africa especially SSA is very low even though by-products such as rice husk is suitable raw material for energy generation and bran is a nutritive ingredient for food formulation [11, 63]. The high amount of silica in rice husk even when mixed with bran as obtained from village mills (Engelberg type mill) is not suitable for animal feeding purposes. In SSA, significant proportion of rice husk produced is disposed of by burning in open fields or abandoned around rice milling facilities [11]. These practices have resulted in the pollution of air, land and water through the generation of greenhouses gases and particles in water and air [64]. This situation calls for urgent and innovative technique to economically utilize the husk and improve rice postharvest handling for sustainable environment.
Rice husk, a by-product of rice milling is about 20% by weight of paddy and chemically contains about 20% SiO2. Gasification technique for rice husk as energy for rice parboiling and household cooking has been recently developed and is being commercialized across the continent of Africa [65]. Five different rice husk top-lit updraft (TLUD) gasifier household cooking stoves for use in rice processing clusters of Africa has been evaluated under a study to select technically feasible rice husk stove for rural and semi urban household cooking and artisanal rice processing in Africa. Ndindeng, et al. [65] study demonstrated that fan-assisted cook stoves especially PO150 recorded better thermal and emission indices and are safer to use than the natural draft gasifiers stove and is therefore recommended for household cooking in rice processing communities of Africa.
Gasification is the process of converting biomass such as rice husk into a combustible gas through thermo-chemical reaction of oxygen in the air and carbon available in the biomass during combustion. In other to gasify rice husk therefore, about 4.7 kg of air per kg of rice is needed [66, 67] and has resulted in the development of several models of fan-assisted rice husk gasifier [65]. The energy obtained are environmentally friendly and the technology easy to use by rural households. Using biomass such as rice husk in Africa for energy generation offers several advantages, including the mitigation of gaseous emissions such as CO2, SOx, and NOX [68]. This is probably due to low amount of sulphur and nitrogen present in agricultural residues as well as minimal chlorine content [69]. But the question arises as to whether some components of emitted gasses by the stove during burning can contaminate the food being processed and exert toxic effects on consumers. Germaine et al. [70] evaluated in vivo toxicity of rice husk used as fuel for household cooking and indicated significantly non toxicity of water boiled with rice husk gasifier. The results obtained by Germaine et al. [70] suggested that rice husk used as fuel in household cooking using a fan-assisted rice husk stove is not toxic at 0.5, 1.0 and 2 ml/100100 g body weight and did not produce any evident symptoms in the acute and sub-chronic oral toxicity studies. Even though no evident symptom of toxicity was observed, Quispe et al., [69] suggested that the use of agricultural residues such as rice husk for energy purpose require the performance of integral assessment considering all stage of its life cycle and comparing same with the use of fossil fuels as a means of identifying the conditions and scenarios for a lower environmental impact. Ndindeng, et al., [65], McKendry, et al., [71, 72] illustrated the following as the main advantages of the innovative rice husk gasification cooking stove introduced in Africa:
Newly introduced rice husk stove had better performance metrics than that of existing brands in the region.
Rice husk mixed with palm kernel shell or other biomass significantly increase burning time but not flame temperature.
Data from end-user evaluation were in conformation with stove performance metrics determined instrumentally.
If the rice husks are completely burned, the amount of CO2 produced is equal to the amount taken from the environment during the growing stage, making it husk gasification and environmentally sustainable practice.
Another advantage is the diversification of energy supply avoiding non-renewable resources depletion which is challenging African forest and farming lands.
Significant improvement has been made in Africa in terms of rice production mainly as a results of the development of new improved varieties, expansion of area under rice cultivation and huge public and private sector investments. This increased production has resulted in increased by-products such as broken rice fractions and husk. Poor utilization of the broken fractions resulted in reduction of productivity of rice and the husks have become of huge environmental and health changes. The high postharvest losses recorded in Africa has become of great concern to research and development experts, and new innovative methodologies were developed to use broken rice fractions for the production of high quality rice flour that could be used to produce high nutrients and consumer acceptable value added products that improve income and food security of smallholder rice value chain actors. The utilization of rice husk for energy generation has also become a fast moving technology where fan-assisted cooking stoves are developed and provide efficient alternative to fossil fuel. Both qualitative and quantitative postharvest losses in rice are being aggressively managed as a strategy to improve food and nutrition security, environmental sustainability and overall productivity of rice production system. Stakeholder including policy-makers, environmental experts, among others, should as a matter of urgency priority consider the use of biomass as sources of energy for home cooking to reduce over dependence on forest woods and popularize the fan-assisted cooking stove among rural dwellers especially among populations in the Sahel region of Africa where desert is moving fast. Utilization of broken rice fraction as raw materials for flour, snacks, porridges and other foods should be encouraged as means of improving food and nutrition security as well as the socioeconomic development of rural areas.
Authors declare no conflict of interests.
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