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  Most popular articles (Since October 30, 2013)

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The story of mouth gags
Faisal Ameer, Arun Kumar Singh, Sandeep Kumar
July-December 2014, 1(2):70-77
Background: Intra-oral surgeries such as cleft palate repair essentially require holding of the jaws in the open position to facilitate access to the oral cavity, which is mostly achieved with the use of mouth gags. Materials and Methods: The objective of this article is to present an account of various types and modifications of gags as surgeons, anesthetists, and innovators attempt to make that ideal mouth gag. The authors present this compendium of development of mouth gags using articles sourced from Medline, surgical catalogs, museums, ancient manuscripts, original quotes, techniques, and illustrations. Results: This article describes notable types and variants of mouth gags with an attempt to classify them. Conclusions: The huge number of modifications done and reports of newer variants appearing at regular intervals goes to prove that we are still far from developing the ideal mouth gag.
  11,707 656 6
Classification of cleft lip and palate: An Indian perspective
Karoon Agrawal
July-December 2014, 1(2):78-84
Classification of the cleft has evolved over a century. Many descriptive, diagrammatic, and coding systems have been proposed to be used. However, there are only few which have stood the test of time. One of them is Indian classification. Indian classification of cleft lip (CL) and palate proposed in 1975 is a popular classification in India presently. There are numerous combinations of cleft deformities, and we found that some of them could not be classified appropriately with the original classification. The clefts are classified in three groups: CL as Group 1, cleft palate as Group 2 and Group 3 for combined CL, alveolus and palate in continuity. Originally right, left, midline, and alveolus were abbreviated. To make the classification wholesome, the original classification has been revisited and presented with additional features. The basic classification in three groups remains as original. Additional abbreviations have been added to classify the special situations. Partial, submucosal, Simonart's band, protruding premaxilla, and microform have been added to the list of abbreviations. This classification has been used for over 30 years by the author in over 4000 cleft patients. We find it simple to use, versatile enough to classify almost all possible cleft combinations, easy for communication during discussion and convenient to write as diagnosis in patients' files. Easy computer archiving and efficient retrieval of the data are the special features of this classification.
  9,567 1,243 -
Complications of cleft palate repair and how to avoid them
Jyotsna Murthy
January-June 2014, 1(1):19-25
Introduction: The cleft palate repair is commonly performed procedure in plastic surgery practices. In addition, this is also procedure done by trainees to the senior most surgeons. One of common procedure for trainee who are introduced to cleft lip and palate surgeries. Literature is flooded with articles on complication of cleft palate repair and probable factors influencing it till the latest one, which suggest that we are far from getting desirable results in cleft palate repair. Review: The common complications of cleft palate repair are fistulae, velopharyngeal insufficiency and detrimental effect on maxillary growth. Palatal fistula is commonly stated in literature with variable incidence ranging from 3-40% 1 , with an average of 7-10%. Other complications are poor speech outcome and poor growth potential of maxillary bone due to scars following palate repair. Every attempt needs to be made to avoid complications or reduce the rate of complications. This article reviews the factors and pitfalls that are likely to increase the chances of complication following palate repair. Conclusion: As surgeon we are duty bound to reduce the avoidable complication, specially related to judgment and techniques. However, the complication due to inherent deficiency of tissue like hypoplastic soft palate muscles and poor scarring tendencies leading to complications are not avoidable.
  7,845 530 1
Buccinator myomucosal flap in cleft palate repair: Revisited
Bhaumik Bhayani
January-June 2014, 1(1):11-16
Objective: To present various ways of transfer and result of buccinator myomucosal flap (BMMF) in primary and secondary repair of palatal cleft and palate fistula. Design: This study has been designed on the basis of a clinical experience and literature search. Route of single or two BMMF(s) transfer was either lateral or posterior to the greater palatine neurovascular bundle. The flap has been used to repair defect in nasal layer, oral layer, or in combined nasal as well as oral layer of the palate. Materials and Methods: More than 160 palatoplasties have undergone palate repair with the use of BMMFs between 1999 and 2011. The analysis includes 98 palate repair. Unilateral flap was used most commonly in primary repair of nasal side of wide unilateral cleft palate (CP); whereas, two flaps were used mostly in primary repair of wide bilateral CP and in secondary palate repair for large fistula. Results: The fistula rate; in primary palatoplasty patients was 4.8% and in secondary palatoplasty patients, it was 8.3%. Good speech has been achieved in primary palatoplasty patients. After secondary palatoplasty also patients had good speech following therapy. Conclusion: The presented technique has been effective in anatomical and functional repair of wide palatal defects primary as well as secondary. The literature has been reviewed along with.
  6,950 596 -
Diagnosis and management of velopharyngeal insufficiency following cleft palate repair
Michael S Gart, Arun K Gosain
January-June 2014, 1(1):4-10
Background: Cleft lip and palate repair seeks to restore normal form, improve feeding and achieve normal speech, which requires velopharyngeal competence. The absence of this ability, termed velopharyngeal insufficiency (VPI), is seen in a wide range of patients following primary cleft palate repair. This review article focuses on patient assessment and the surgical management of VPI. Recent trends and future directions in management are also presented. After reading, one should be able to describe the various treatment approaches for a patient with suspected VPI. Materials and Methods: A PubMed search was conducted using the following search terms: VPI, velopharygneal incompetence, VPI, velopharynx, velopharyngeal port, velopharyngeal mechanism, veloplasty, intravelar veloplasty and hypernasal speech. Relevant manuscripts were identified by abstract review and additional articles selected based on bibliography review. Articles were restricted to those in the English language. A total of 88 articles were selected for further review. Conclusions: VPI is a common complication following primary palatoplasty. The decision to operate, as well as the selection of operative procedure, depends on a multimodal patient assessment, including speech evaluation and imaging studies of the pharyngeal mechanism. A thorough understanding of velopharyngeal anatomy and physiology is crucial to understanding the deficits in patients with VPI as well as the myriad methods of surgical correction. While many techniques are available, there are no conclusive data to guide procedure choice and newer techniques of imaging and treating patients with VPI continue to evolve.
  6,524 548 1
Repair of cleft palate: Evolution and current trends
Chona Thomas
January-June 2015, 2(1):6-10
The management of a patient with cleft palate is complex. Various prevalent surgical techniques are presented, but no universal agreement exists on the appropriate treatment strategy. There is a consensus of opinion that normal speech should be the most important consideration in the therapeutic plan. Growth disturbance should be minimized, but not at the expense of speech impairment because facial distortion can be satisfactorily managed by surgery, whereas speech impairment can often be irreversible. There is a need for well-controlled, prospective studies to establish the validity of the widely different claims of superior results from various techniques. Cleft patients should be managed in a center with a multidisciplinary team. Cleft palate remains a significant and interesting challenge for current and future plastic surgeons.
  6,408 606 -
Fronto-orbital advancement: Revisited
Derick Mendonca, Somashekar Gejje, Nitin Kaladagi
January-June 2015, 2(1):20-26
Introduction: Craniosynostosis is a pathologic condition resulting from the premature fusion of cranial vault sutures, resulting in craniofacial deformities. Anterior craniosynostosis can involve a combination of metopic/unicoronal or bicoronal sutures. Aims and Objectives: Fronto-orbital advancement (FOA) is the standard surgical treatment. This article attempts to highlight the importance of modifying the osteotomies and reshaping of the cranial vault based on individual requirements to achieve the best possible result. Method and Results: Three consecutive cases of anterior craniosynostosis (metopic with unicoronal, unicoronal with sphenoethmoidal, bicoronal) with individual modifications of the technique used in each case are presented. Conclusion : FOA has to be tailored for each variant of anterior craniosynostosis and its requirements. The Technical variations can be applied to any combination of anterior craniosynostosis.
  5,919 309 2
Clinical profile and treatment status of subjects with cleft lip and palate anomaly in India: Preliminary report of a three-center study
OP Kharbanda, Karoon Agrawal, Rakesh Khazanchi, Suresh C Sharma, Sushma Sagar, Manish Singhal, Neeraj N Mathur, Kumud Kumar Handa, Madhulika Kabra, Neerja Gupta, Neeraj Wadhwan
January-June 2014, 1(1):26-33
Context: Treatment of patients with cleft lip and palate (CLP) anomaly requires a multidisciplinary approach from birth until adulthood. Many children with cleft anomaly are born in rural areas where resources for treatment and awareness on cleft care are limited. Consequently, many patients may receive limited or suboptimal care due to multitudes of reasons. Aims: The current study was aimed to record the baseline data on the spectrum of clinical profile of cleft patients, treatment protocols, quality of treatment and the residual treatment needs of patients with CLP anomaly visiting three major hospitals across Delhi and National Capital Region (NCR). The experience gained from the three-center study would be used to lay a framework to conduct a nationwide multicenter study in terms of logistics, feasibility and difficulties. Materials and Methods: The study titled "CLP anomaly in India: Clinical profile Risk factors and current status of treatment: A hospital based study" was started in 2010 as a Task Force project of Indian Council of Medical Research. The Pilot phase, which started in 2012, encompassed three cleft centers across Delhi and NCR, namely, All India Institute of Medical Sciences, Safdarjang Hospital and Medanta - The Medicity. Data for 126 non-syndromic CLP subjects was recorded on a specially designed performa. Each case was evaluated by a team of specialists comprising of a Plastic Surgeon, an Orthodontist, ENT Surgeon, Dental Surgeon, Speech therapist and an Audiologist. Clinical records included profile and intraoral photos, dental study models, audiometric and speech evaluation data. The current paper attempts to highlights a few of relevant observations of the pooled data from three centers. Results and Conclusions: The results indicate a lack of uniform protocol followed in providing care to cleft patients. A great variation was found in the quality of treatment received by many of the patients.
  4,151 363 1
Increased frontonasal angle and surface area of mandibular antegonial notch; reliable signs of Treacher Collins syndrome
Gyan P Singh, Sneh Lata Verma, Pradeep Tandon, Divya Mehrotra
January-June 2014, 1(1):65-68
Background: Treacher Collin Syndrome is one of the most disfiguring congenital anomalies of the face, the visible part of the human body used for the identification of an individual. It is an inherited disorder in which there are bilateral symmetric anomalies of the structures within the first and second branchial arches. In general, there is complete penetrance and variable expressivity of the trait. Increased frontonasal angle and deep antegonial notch are syndrome specific characteristic distinguishing Treacher Collin Syndrome from other Syndromes. Main objectives of the presenting this case are to evaluate the validity of the aforementioned clinical signs for the diagnosis and to find out the significance of the surface area of antegonial notch in patient suffering from Treacher Collins syndrome. Methods: Persons of two generations of a family effected with Treacher Collins syndrome were examined for two cardinal signs traditionally associated with this disorder along with the normal siblings of the second generation for the above parameters. Conclusion: Significantly increased fronto nasal angle, frontal sinus area and deep antegonial notch was found in the father and son exhibiting characteristic signs of Treacher Collins-Franceschetti Syndrome in comparison to normal individuals of the family.
  4,216 126 -
Functional and speech outcomes of superiorly based flap pharyngoplasty combined with radical intravelar veloplasty
Abdelrahman E. M. Ezzat, Rana A Khalifa, Mabrouk M Akel, Hanna M El-Shenawy
January-June 2015, 2(1):41-48
Objective: The aim of this study was to evaluate functional and speech outcomes of superiorly based pharyngeal flap (SBF) pharyngoplasty combined with radical intravelar veloplasty (RIVVP) for the management of velopharyngeal insufficiency (VPI) following surgically repaired cleft palate. Design: A case series with chart review. The study was conducted in academic tertiary care medical centre. Patients and Methods: Fifteen patients with VPIs following surgically repaired cleft palate were managed between May 2011 and August 2014, with SBF pharyngoplasty combined with RIVVP. Results: We found that the speech defects improved by a success rate of 93.4%; the VP function became normal (circular pattern of closure) in 80% of patients and the postoperative overall success rate of VP competence grades was 93.4%. Moreover, we found that the overall incidence of complications were 33.3%. Conclusion: By doing SBF pharyngoplasty combined with RIVVP the surgical procedure was satisfactory in both functional and speech outcomes.
  3,745 444 -
Large midline persistent parietal foramina with occipital encephalocele and abnormal venous drainage
Parag Agarwal, Mithelesh Pandey, Sunil Baranwal, Kaushik Roy
January-June 2015, 2(1):66-69
Enlarged persistent parietal foramen is rare congenital skull defect and associated anomalies like underlying encephalomalacia, and venous malformations are known. We here report a very rare association with persistent occipital foramina and occipital encephalocele. This patient presented later in life with complaints of headache and seizure. Basic clinical examination like palpation of scalp was helpful in diagnosing this rare condition. Radiological investigations later revealed an array of associated congenital abnormalities like hypoplastic inferior sagittal sinus, which is even rare finding in a single case.
  3,783 103 2
Craniofacial microsomia
RK Mishra, Surajit Bhattachrya
January-June 2015, 2(1):11-19
Craniofacial microsomia (CFM) is the second most common craniofacial anomaly treated surgically in craniofacial centers worldwide. This craniofacial condition is variably associated with anomalies of the ears, jaws, orbits, soft tissue of face and function of the facial nerve. It can also be associated with extra-cranial deformities like cervical and rib anomalies. Largely, the etiology of CFM is unknown, but prenatal exposures of some drugs and genetic abnormalities may be associated with the condition. Diagnosis and treatment of CFM is challenging due to a wide spectrum of deformities (both osseous and soft tissue). Depending upon the severity of the deformity a wide variety of surgical treatment plans exist. After treating forty cases of CFM, we experienced that, though the treatment of severe form of CFM is difficult, but a coordinated multi-specialty team approach, especially of Reconstructive plastic surgery, orthognathic surgery, ear, nose and throat specialists leads to a successful and rewarding outcome.
  3,480 214 -
Management of lateral lip element in rotation advancement technique for cleft lip repair: Tips and tricks
Gaurav S Deshpande, Alex Campbell
July-December 2014, 1(2):104-108
A new era in cleft lip repair began when Dr. Ralph D Millard introduced his technique of rotation and advancement. In 1987, Mohler described a variation of Millard's unilateral repair that included a columellar extension. In 2005, Fisher introduced the principle of anatomic subunit closure. These techniques can work very well across the spectrum of unilateral clefts of the lip, though challenges arise with wide clefts and those where there is a large discrepancy between the greater lip height and lesser lip height. In cases when the discrepancy is high, the surgeon often tries to gain the necessary lip height on the cleft side by shifting the Noordhoff's point more laterally, sacrificing excessive tissue. This often results in a lateral lip that is hypoplastic, giving an unnatural look to the repaired upper lip. Focus has traditionally been on getting the necessary lip height, sacrificing fullness of the lateral lip element. This paper describes several strategies to optimally manage the lateral lip element in rotation-advancement technique for unilateral cleft lip repair. The results with this technique are encouraging and can be utilized to offset the drawbacks of rotation-advancement technique in very wide and short cleft lips.
  3,333 315 1
Moustache restoration after cleft lip repair
Rajendrasingh Jalamsingh Rajput
July-December 2015, 2(2):129-132
Background: We strive to achieve a functional and aesthetic repair in cleft lip patients bestowing them with all natural landmarks and making the evidence of the repair undetectable for better quality of life and complete social acceptance. The last to offer is a moustache for an adolescent male cleft lip patient. Aim: The current study is a review of moustache restoration carried out for patients after cleft lip repair. It includes 18 cases with a follow-up of 6 months to 2 years. Materials and Methods: Follicular unit extraction using 0.9 mm motorized punches is the preferred technique. Alternative method is follicular unit transplant strip technique, where individual hair follicles are dissected for a 0.5-0.6 cm × 5-6 cm strip of scalp. Each follicle serves as a micro graft. Grafts are implanted in premade needle tracks flush to the skin. Spacing is 2-3 mm in the first sitting. Second sitting may be planned 6-8 months later to add density. Results: Hair growth along the scar is delayed, it begins 4-5 months after the transplant, and complete growth is seen by 6 months. There can be 7-10% loss of grafts. Conclusion: Follicular unit micro grafting can be used for restoration of moustache after a complete cleft lip repair. Moustache provides animation of the face, restoration of aesthetic landmark, taking away the typical cleft lip look and building up confidence of the patient.
  3,491 99 -
Oropalatal dysplasia: A case report with an innovative sequence of reconstruction
Karoon Agrawal, Sanjay Kumar, Rakesh Kumar Srivastava, Mukund Gupta
January-June 2014, 1(1):55-58
A rare syndromic cleft palate child with microstomia and ankyloglossia is presented. The child presented at 1-month of age with microstomia, complete cleft of the secondary palate, ankyloglossia with dorsal groove of the tongue. There was no family history of oropalatal anomaly. This is a case of Bettex Graf Syndrome. The karyotype was normal 46XY. The reconstructive surgery was delayed to facilitate anesthesia and surgery. The reconstruction was carried out in one stage with an innovative sequence. Microstomia was released using Y-V plasty; palate repair was carried out with Bardach's two flap palatoplasty and ankyloglossia was released with V-Y technique. The child has been followed-up for more than 6 months. Mouth opening is satisfactory, though there is recurrence of microstomia. Child is able to protrude the tongue well, however, it remains grooved.
  3,393 104 -
A rare case report of intermediate osteopetrosis and review of literature
Priyanka Verma, Sonali Kadam, Hemant Rangnath Umarji, Varun Surya
July-December 2014, 1(2):127-131
Osteopetrosis also known as "marble bone disease" is a group of rare genetic disorders caused by osteoclast failure, which ranges widely in severity. Osteopetrosis presents with a spectrum of craniofacial abnormalities such as frontal bossing, macrocephaly, hydrocephaly, and cranial hyperostosis. Osteopetrosis is caused by failure of osteoclast development or function and mutations in at least 10 genes have been identified as causative in humans, accounting for 70% of all cases. These conditions can be inherited as autosomal recessive, dominant or X-linked traits with the most severe forms being autosomal recessive. We present a rare case of osteopetrosis in a 10-year-old boy who reported with an unhealed socket after tooth extraction. The characteristic clinical and radiographic findings were suggestive of intermediate osteopetrosis.
  3,318 139 -
Pathologic anatomy of the soft palate, part 2: The soft tissue lever arm, pathology, and surgical correction
Michael H Carstens
July-December 2017, 4(2):83-108
Pathologic anatomy of the soft palate, part 2: The soft tissue lever arm, pathology, and reconstruction. In part two, we consider the soft tissue components of the soft palate: Epithelium, fascia, muscles, arterial supply, and innervation. These velar tissues constitute a functional “lever arm” for control of speech and swallowing. Fascia and peripheral nerves arise neural crest originating from rhombomeres 2–7. Muscles arise from paraxial mesoderm (PAM) of somitomeres 4, 6, and 7. Lateral plate mesoderm lying outside of PAM provides the building blocks of the circulatory system. Neurovascular analysis discloses the soft palate to have three developmental zones with distinct sources of neurovascular supply. Emphasis is placed on the anterior third of the palatine aponeurosis; this critical structure determines where the levator complex will insert. The basic field defect of soft palate clefts arises from insufficiency of the lesser palatine neurovascular pedicle affecting the posterior palatine shelf and anterior 1/3 of the palatine aponeurosis. This leads to forward displacement of the levator complex and pathologic insertion onto the bony margin of the cleft site. Soft-tissue disruption will then be presented in terms of the simple genetic loop between bone morphogenetic protein 4 (BMP-4) and Sonic hedgehog. The migration of soluble factors such as BMP-4 from their origin with developing bone to the free border of the epithelium permitting fusion of adjacent structures.
  3,239 178 1
Diprosopus dirrhinus: A rare case report
Prabir Kumar Jash, Debarati Chattopadhyay, Nonavinakere Prabhakera Sunil, Souradip Gupta
July-December 2014, 1(2):122-123
Diprosopus or craniofacial duplication is an extremely rare craniofacial anomaly. It is the rarest form of conjoined twins. One of the types of incomplete facial duplication is the duplication of nose known as diprosopus dirrhinus, of which there is only a single case report from India to date. In the present article, the authors describe a 5-year-old boy having diprosopus dirrhinus with severe hypertelorism, right cleft 12 and right upper eyelid coloboma, a combination of anomalies which have not been reported to date.
  3,080 84 -
Cleft lips and palates: A societal perspective
Satish Kalra
July-December 2014, 1(2):100-103
The congenital anomaly of cleft lips and palates is probably more misunderstood than most. The attitude of National Governments, medical professionals and society at large often ranges from unsympathetic to callous. Luckily this is changing and bringing more cleft affected people back into the mainstream than at any other time in history. But there's still a long way to go.
  2,942 117 1
Reconstruction of the superior gingiva-labial sulcus in bilateral cleft lip palate patients: Our experience
Divya Narain Upadhyaya, Arun K Singh, Vijay Kumar, Brijesh Mishra, Veerendra Kumar
January-June 2014, 1(1):48-51
Introduction: In many bilateral cleft lip palate patients the prolabium often remains adherent to the premaxilla and the upper alveolar-labial sulcus is absent. Cleft surgeons have struggled with this problem for many decades and a number of procedures have been described in the literature to correct this deformity. Materials and Methods: A retrospective review of the records of all patients who underwent upper gingivobuccal sulcus reconstruction between August 2003 and December 2012 was carried out. Results: A total of 97 patients were underwent upper gingivolabial sulcus reconstruction with full thickness skin graft from August 2003 to December 2012, a period of 9 years and 5 months. Discussion: An adequate sublabial or gingivolabial sulcus is crucial to both the function as well as the esthetics of the upper lip. Paucity of tissues in bilateral cleft lip and palate patients during lip repair often leads to a 'tight' repair with little or no sulcus at all. The full thickness skin graft has many benefits. It can be harvested in greater quantities than the mucosal graft, takes well, is hairless and does not contract or harden to any significant degree. One significant disadvantage of the skin graft in the upper labial sulcus is its pigmentation that can continue to irk the patients even after several years and probably forever.
  2,870 155 -
Effects of nasoalveolar molding therapy on alveolar morphology in unilateral cleft lip and palate using two different approaches
Puneet Batra, MV Ashith, Shaksham Mittal, Akhter Hussain, Khader Mustafa, Sudeshwar Sood
July-December 2015, 2(2):107-112
Objective: The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy by standard Grayson technique (G1) and Yen Modification single step NAM technique (G2) on alveolar tissues in patients with unilateral cleft lip and palate (UCLP) using three-dimensional digital models. Materials and Methods: Totally, 10 patients with a mean age of 20 ± 16.07 days, having complete UCLP, were included in this prospective study. The maxillary plaster models were scanned. The study sample was divided into two group of 5 UCLP patients (G1 treated by standard Grayson technique and G2 treated by Yen Modification) for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured on the maxillary casts, and the distance and area measurements were performed using software Poly works (IIT Delhi). All subjects had undergone PNAM therapy for 3 months, the alveolar segments should have been approximated (≤5 mm), and the cleft width after PNAM should be reduced. Results: The decrease of the cleft width and arch length on the cleft side were significantly altered on the affected side (P < 0.005). No significant changes were observed when comparing both the groups using standard Grayson technique and Yen Modification single step NAM technique (G1 and G2). Conclusion: PNAM therapy effects mainly in the anterior alveolar segment and reduction of palatal and alveolar cleft width in patients with unilateral clefts of lip, alveolus, and palate in both Grayson and Yen Modification single step NAM technique. Both the Groups G1 and G2 suggested same treatment outcome in term of alveolar molding, but single step technique reduces patient's visits.
  2,297 694 -
Association of cervical vertrebra anomalies with cleft lip and palate
Mudita Srivastava, Anshul Aggarwal, Puneet Batra, Sangeev Datana, Prasanna Kumar, Klara Agneta Macrcusson
January-June 2014, 1(1):43-47
Introduction: The aim of the present study was to evaluate the developmental relationship in the vertebral column in the cervical region and to relate its association in patient's with cleft lip and palate. Materials and Methods: The sample consisted of 228 cleft patients in the experimental group and 225 non cleft samples in control group. Cleft patients are subdivided into cleft palate only (CPO), Unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Cervical vertebrae were traced on lateral cephalogram in children with cleft lip and palate to determine the prevalence of vertebral anomalies and their categorization. The cervical vertebral anomalies were classified into two types: posterior arch deficiency (PAD) and fusion anomalies (FUS). Results and Conclusion: The study showed 19 percent of cleft patients with cervical vertebral anomalies and 4 percent of control group with cervical vertebral anomalies. Posterior arch deficiency occurred more frequently in unilateral cleft lip and palate(UCLP) and cleft palate only (CPO), Fusion occurred significantly more often in bilateral cleft lip and palate (BCLP).
  2,769 158 1
Primary rhinoplasty at the time of unilateral cleft lip repair: A review and our protocol
Puthucode V Narayanan, Hirji Sorab Adenwalla
July-December 2015, 2(2):92-97
The cleft lip nasal deformity has been well described. However, for a long time, cleft surgeons feared that repair of the cleft lip nose at the time of primary repair would cause a growth disturbance especially of the nose. Hence the nasal deformity was not repaired until later. However, from the time of Blair and Barrett Brown, it has been shown that there are no deleterious growth effect from primary nasal interventions. At our centre the senior surgeon has performed primary nasal correction including septal respositioning from the late 1960s. There has been no deleterious growth effect and the overall appearance of the nose has actually improved. This is now well established through many objective studies. Hence it is now imperative that the deformity of the nose including the septum be addressed at the time of primary unilateral cleft lip repair.
  2,568 332 1
Incomplete median cleft of lower lip with ankyloglossia
Anil Kumar Desai, Niranjan Kumar, Sandhya S Pavate, Dharani Ramarathinam
January-June 2015, 2(1):63-65
Median cleft of lower lip and mandible is a rare congenital anomaly and is also described as Tessier's no 30 cleft. It is also associated with other congenital abnormalities with varying degree of severity. The condition was first described by Couronine in 1819 and since then very few cases have been reported. We report a case of median cleft of lower lip and ankyloglossia, which was surgically treated. The etiology, clinical feature and treatment are discussed.
  2,770 108 -
Surgical correction of severe bifid nose
Sinan Ozturk, Fatih Zor, Selcuk Isik
July-December 2014, 1(2):115-118
Craniofacial clefts cause severe facial disfigurement even in minor forms. The surgical reconstruction is imperative to restore function and appearance of facial structures. The presentation of Tessier number: 0 cleft patient may vary from minimal changes on median facial structures such lip, vermilion and nose, and nose to wide clefts dividing all median craniofacial structures. The variability of expression of the unusual orofacial clefts can be challenging for the surgeon, while reconstructing affected facial structures. In this report, we present the surgical management of the case with severe bifid nose. A 27-year-old male presented with congenital midfacial disfigurement with hypertelorism. The patient had a flat nasal dorsum and a deep groove between the two alar domes. The nose was short and bifid. The patient did not accept facial bipartition surgery. We performed de-epithelialization on the skin groove between the two alar domes. We repaired lower one-third part of the nose with native nasal tissues. We reconstructed upper two-third part of the nose with the osteocartilage frame harvested from the calvarium and the nasal septum. Two superiorly based-nasolabial flaps were designed with sufficient length to provide external cover of the osteocartilage frame. In case of the severe bifid nose, osteocartilaginous and soft tissue structures of the nose must be restored separately. Following reconstruction of the osteocartilaginous framework with nasal tissues or grafts, remaining nasal soft tissue, and local flaps can be used to cover the soft tissue.
  2,700 111 1