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Biomedical subjects

R W Pigott

Publications and source records attributed to R W Pigott.

At least 19 recordsLinked to original sources
PubMed1992

Early postoperative complications in primary cleft lip and palate surgery--how soon may we discharge patients from hospital?

A retrospective review of the early complications of primary cleft lip and palate surgery in one Plastic Surgery Unit was conducted and the results are presented. Out of 164 primary procedures performed there was an overall complication rate of 26.2%. The life-threatening complications were all related to the respiratory system and all but one of these occurred within 2 days of operation.

Blood Loss, Surgical↗
PubMed1991

Effectiveness of burns resuscitation using two different formulae.

Prior to 1989 burns were resuscitated at the Burns Unit Frenchay Hospital according to the Mount Vernon formula. In 1989 a 33 per cent modification was introduced as suggested by Watson, Walker and Sanders. The aim of this study was to examine retrospectively the effects of the resuscitation protocols on morbidity and mortality. The total numbers of burns admitted to Frenchay in 1988 were 93 adults and 58 children. This compares with 82 adults and 55 children admitted in 1989. Of these, approximately one-fifth required intravenous resuscitation. No statistical difference was found between the two groups for age, body weight, distribution of burn, or delay in arriving at the burns unit (taken from the time of burn). In both years the volume of albumin used in resuscitation exceeded the calculated requirement after the third period (P less than 0.05). The 1989 patients were transfused with greater volumes, resulting in increased urine output (P less than 0.001). No difference in morbidity or mortality was shown. However, the investigation did show that the 1989 patients achieved urine outputs indicative of overtransfusion. It is concluded that the Watson-Walker modification is unnecessary and possibly undesirable.

Adolescent↗
PubMed1990

Submucous cleft palate in the differential diagnosis of feeding difficulties.

Submucous cleft palate is a missed or forgotten diagnosis. We reviewed 81 patients with submucous cleft palate seen over a 15 year period; 26 of these patients were interviewed. The patients were divided into three main groups according to the referral pattern. Children under 2.5 years were referred by a paediatrician for feeding problems; children aged 2.5-10 were referred mainly by speech therapists; and those over 10 had a varied pattern of referral. Thirty nine of the 81 had problems with feeding, but of the 26 interviewed, 22 had feeding problems. Not all patients with a submucous cleft palate are symptomatic and require active treatment, but children with this condition have the same high incidence of middle ear disease as those with overt cleft palate. We suggest that the diagnosis of submucous cleft palate be included in the differential diagnosis of feeding difficulties, with early referral to a specialist cleft palate team.

Adolescent↗
PubMed1988

The "tadpole flap"--its role in closure of palatal fistulae.

"Tadpole flaps" have been used in a series of 13 cleft palate patients in attempts to close anterior palatal fistulae over a 5-year period. The technique was successful in eight patients whose fistulae remained closed. The failures are discussed in detail.

Adolescent↗
PubMed1988

Aesthetic considerations related to repair of the bilateral cleft lip nasal deformity.

A study of the changing configuration of the nose tip with age shows that the columella naturally takes a greater share of nose tip projection with increasing age. In the infant and small child, when most repairs are done, nose tip projection is due more to the alar dome component than to the columella. Over-lengthening the columella at the expense of alar dome projection results in an unaesthetic nose at maturity. The nasal correction should be towards a normal proportion for age and attention must be paid to alar dome configuration. Where the inferior view shows a "tent tip" skyline, lateral crus advancement is required and can be achieved in asynchronous repairs by Pigott alar leapfrog at primary repair or by Potter V-Y advancement at the time of forked flap columella lengthening. The profile view of the nose and lip shows that the lip "drops" from a point about two-thirds of the way from nostril apex to alar base. A key stitch advancing the alar bases at the time of columella lengthening allows the philtral area to bow forwards as a prow so that it comes to lie in a normal relationship with the columella in the profile view.

Adult↗
PubMed1987

A computer-based method of measuring facial asymmetry. Results from an assessment of the repair of cleft lip deformities.

The appearance of the nose, mouth and nostrils was analysed in two series of unilateral, complete cleft lip patients. A programme was written for use on a BBC microcomputer to measure the symmetry of facial features traced from photographs. Symmetry was measured using one of two methods: determining the area of non-overlap when one side was reflected on the other (area method) or calculating the distance from regularly spaced points on the outline of one side to the nearest point on the reflection of the opposite side (curve method). The rankings of the photographs based on these results were compared with the subjective rankings given by a lay panel. The results based on the curve method agreed well with the subjective rankings (P for Spearman Rank Correlation Coefficients = less than 0.02). The technique provides a cheap, simple and quick method of comparing symmetry in groups of patients.

Adolescent↗
PubMed1987

Objectives for cleft palate repair.

Improved anesthesia and nutrition are permitting earlier safe cleft palate repair, with higher success rates. Three factors that are considered necessary to obtain satisfactory function of the soft palate for speech are (1) adequate length, (2) adequate mobility, which should include consideration of resting tension and elasticity of the levator and depressor muscles, and (3) the need for conformity of the dorsal surface to the pharyngeal wall, which this paper seeks to emphasize. These concepts are examined with reference to the literature and observations made by the author from endoscopic and x-ray studies and from electrical stimulation of the palate muscles prior to palate repair. A technique for relocating the musculus uvulae is described. It is concluded that at least 9 out of 10 palates are long enough at birth and have sufficient mobility, provided that this is not impaired iatrogenically, to obtain satisfactory speech. Emphasis needs to be placed on providing a normal dorsal convexity and, where levator activity appears to be inadequate, means need to be found whereby inappropriate activity or tension of the palate depressors can be diagnosed and effective treatment devised.

Cleft Palate↗
PubMed1987

Hynes pharyngoplasty revisited.

The treatment of velopharyngeal incompetence remains unsatisfactory because the causes are many, as are the variations in anatomic and physiologic defects. Therefore, full assessment and investigation are essential in tailoring the surgery to the defect. A modified Hynes pharyngoplasty has been used in 40 patients, aged 4 to 52, over a 4-year period for velopharyngeal incompetence of varying etiologic causes. Speech was assessed before and at least 6 months after pharyngoplasty. At the same time, radiologic and, when possible, nasendoscopic investigations were undertaken. Thirty-eight patients had no or variable nasal escape (variable defined as achieving intermittent closure), whereas 33 had normal or slight hyponasal resonance. There was only one complication, an asymptomatic dehiscence of the "bucket handle" flap from the posterior wall. Thirteen patients had an assortment of side effects, none requiring surgical treatment. We believe that patients who are suitable for the described sphincter pharyngoplasty are those with slight or moderate nasal escape having a mobile palate with an anteroposterior gap of 5 mm or less.

Adolescent↗
PubMed1986

Pharyngoplasty: a hazard for nasotracheal intubation.

General anaesthesia is desirable for a wide range of oral and maxillofacial operations and nasal intubation is essential for some procedures, particularly orthognathic surgery. The patient who has undergone pharyngoplasty presents with a reduced velopharyngeal orifice which may interfere with the insertion of the nasal tube. It is suggested that nasal pharyngoscopy or a similar investigation should be included as part of the preoperative assessment for these patients if nasotracheal intubation is anticipated.

Adolescent↗
PubMed1985

"Alar leapfrog". A technique for repositioning the total alar cartilage at primary cleft lip repair.

A technique is described to reconstruct the normal degree of projection of the alar dome of the unilateral cleft lip nose by leapfrogging the spreadeagled alar cartilage up onto the back of the sturdy septum and upper lateral cartilage arch. The medial crus enclosed in a hemiforked flap slides along the membranous septal incision; the lateral crus slides along the intercartilaginous incision; they join each other as the stem of a Y, where they are secured in their new relationship to the septum and upper lateral cartilage. As the limbs approach each other, a standing cone creates the dome projection externally and a fornix within. The dipped rim rises and the charming nasal dimple reappears. Almost 200 primary cases of unilateral cleft lip nose have been treated by this technique over the past 12 years by the author. Alar dome and alar rim relapse have been infrequent. Less than 5 per cent of patients (or parents) have requested revision up to puberty. Final assessment of the effect of this radical surgery may well require a further 10 years' follow-up.

Airway Obstruction↗
PubMed1984

Tongue flap repair of cleft palate fistulae.

In a series of 20 patients with palatal fistulae that were judged beyond closure with local tissue alone, the fistulae were successfully closed with tongue flaps in 17 patients (85%), 6 of whom required an additional minor procedure. The social stigma of fluid leaking from the nose was corrected in all patients and, in the older age group, several patients no longer had to wear obturators. Speech was improved in 9 patients due to a reduction in hypernasality and in 8 patients, articulation was noticeably improved. The anteriorly-based tongue flap has proved to be a reliable way of closing the difficult fistula where symptoms are sufficient to justify the attempt. The procedure was used successfully in all three children under 2 1/2 years on whom it was used.

Adolescent↗
PubMed1982

The feasibility of nasal pharyngoscopy using the 70 degrees Storz-Hopkins nasopharyngoscope.

In a sample of 100 patients of all ages with velopharyngeal incompetence the overall success rate in passing the Storz-Hopkins 70 degrees nasopharyngoscope was 83%. The seventeen failures occurred in children under 10. In a group of 110 children between 3 and 11 years old, success rates for pre-school children were less than 50%, but for primary school children the success rate rises to 75% in the eighth year and failures over the age of 10 are exceptional. The possibility that unilateral cleft patients and neurological patients would have a worse prognosis for age could not be confirmed statistically in this sample. From a practical point of view endoscopy with this endoscope should be reserved for children of school age (over 5), unless the child seems particularly self-possessed, in order to have reasonable chance of success and to avoid prejudicing the child against subsequent and perhaps more essential examination.

Age Factors↗
PubMed1982

Some characteristics of endoscopic and radiological systems used in elaboration of the diagnosis of velopharyngeal incompetence.

The characteristics of rigid and flexible endoscopes have been studied with reference to their suitability for nasal pharyngoscopy in the assessment of velopharyngeal incompetence taking into account a number of fallacies which are known to exist. It is concluded that the ability to achieve correct positioning of the rigid endoscope and the wide angle field of view of the 70 degrees Storz-Hopkins nasopharyngoscope, in particular, made it the best single instrument at present available for this work despite the greater ease of introduction of the flexible endoscopes. The characteristics of the information obtained by radiological examination were studied and in comparison with endoscopic information it was concluded that endoscopic information was more reliable for qualitative and radiological for quantitative analysis. The systems were considered to be mutually complementary and simultaneous examination with, preferably, synchronous recording provided the advantages of optimal placement of the endoscope and the possibility of measurement of the velopharyngeal isthmus.

Barium Sulfate↗