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A method of open-tip rhinoplasty using nostril and columella rim incisions at the time of unilateral cleft lip repair is described. This preliminary report details experience gained using this technique in the Malaysian centre of Alor Setar following its introduction in September, 1991.
The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Primary cleft surgery and surgery to correct the secondary deformities of previous non-functional repair should aim to restore normal anatomy and physiology, with an emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be encouraged.
Since 1987, we chose a neonatal repair of the cleft lip and nose and closure of the cleft palate at 3 months of age. Ventilation tubes are systematically inserted in the drums at time of palatoplasty. Alveolar clefts are grafted when canine erupts. Secondary correction, which might be early, are scheduled according to functional, aesthetic or psychological demands. A interdisciplinary follow-up by a stable and united team is essential for an adequate management of sequels.
Maxillary morphology and occlusal development were studied after simultaneous velar closure and lip/nose reconstruction in patients with unilateral cleft lip and palate. Fifty-two Brazilian patients were divided into three groups according to the age at which they had had the one-stage operation (mean ages: 8, 18, and 77.5 months). They were compared with 30 similar white patients who had been operated on with a corresponding method, but where surgery had been carried out in three different stages. In general, differences in outcome between the groups were attributed to racial differences in facial morphology. The combined operation did not affect the transverse development or the overall occlusion and only slightly influenced the morphology of the maxillary incisor region. The palatal cleft width reduced significantly (p < 0.001) after the combined procedure. However, the potential for this reduction seemed to be less when patients were operated on after their first year of life.
This case probably represents the youngest such patient reported in the literature. The large upper lip defect due to a dog bite has been primarily and successfully repaired with an Abbé flap.
This study was designed to test the effects of pursed lips breathing (PLB) during exercise in patients with chronic obstructive pulmonary disease (COPD) who did not spontaneously perform PLB. Sixty-nine COPD patients, mean FEV1 (SD) 1.09 (0.5), age 68 (51-83) were recruited to the study. They performed three incremental shuttle walk tests (ISWT). The first walk was designed to identify natural PLBs and the next two walks were performed in a random order; ISWT + PLB or ISWT whilst breathing normally. Measures of respiratory rate (RR), breathlessness and oxygen saturation were taken before and after walks. Data was analysed using the t-test. Fifteen patients demonstrated PLB on baseline ISWT and were therefore excluded from further walking tests although baseline data was included in the analysis. There was no significant difference between walks, mean (SD), 298.5 (173.7) PLB and non-PLB; 292.5 (161.9) nor any difference in dyspnoea. There was a significant reduction in end exercise RR and recovery time with PLB, mean difference (95% CI); 6.2 (4.5-7.9) and 24.9 (2.8-47.0) seconds, respectively. Patients who showed a good response with the PLB walk (41%) had significantly higher baseline breathlessness, Borg score, mean (SD), 1.5 (1.0) versus 0.74 (0.96) (P = 0.02). Natural PLB patients demonstrated lower exercise tolerance on the baseline walk (P = 0.01) and a trend towards greater resting breathlessness than those who did not. This study shows PLB during exercise and recovery results in lower post exercise RR and speeds return to pre exercise breathlessness, compared with exercise and non-PLB. Reductions in RR appear to be greatest in those patients with resting breathlessness.
Co-ordination of maxillary orthopaedics with two-stage lip surgery according to the Celesnik principle for complete BCLP is described, and the results of the procedure are analyzed at the 10 to 15 year age level. Taking advantage of the effects of growth within the first 6 to 8 months of the patient's life, orthopaedics and concomitant surgery achieve a considerable degree of alignment and stabilization of the praemaxilla within the alveolar arch without reverting to any active orthopaedic retrusion. Around age 10 the praemaxilla has assumed a normal sagittal position relative to the anterior cranial base. Due to relatively short and retropositioned mandibles all cases in the sample investigated display rather receding 'Class II type' profiles in early adolescence.
In a cross-sectional study of 106 European children with unilateral complete cleft lip, alveolus and palate ranging from 10 to 15 years of age, dental maturity was determined using orthopantomograms. The method and standards (the 50th percentile line) of Demirjian were used. The study shows a significant delay of dental maturity in both male and female cleft-affected patients. This delay in tooth development supports Van Limborgh's theory that the origin of clefts is due to the delayed growth and development of parts of the dentofacial area.
A 24-year-old man presented with a carbuncle of the upper lip. Surgical drainage was installed and flucloxacillin was administered. Full recovery ensued. In culture Staphylococcus aureus was abundant.
In assessing 143 infants with cleft lip and palate, we found feeding problems to vary with the patients' anatomic lesion. Effective feeding techniques were identified by first assessing the infant's ability to generate negative intraoral pressure and to move the tongue against the nipple and then by matching these deficits to appropriate feeding devices.
The "D. E. F.-syndromes" consist of ectodermal dysplasia, cleft of the lip and/or palate (fente labiale et/ou palatine). This group includes the A. E. C.- and the E. E. C.-syndromes. We are reporting two cases of D. E. F.-syndrome, in which there was a very particular hair dysplasia, which we named "scrubbing-brush hair". The first case was a boy. The disease was probably transmitted on the dominant autosomal mode. The ectodermal dysplasia was of hypohidrotic type. The second case was also observed in a boy. There was no similar genetic abnormality in the family. The ectodermal dysplasia was of hidrotic types. The embryological findings account for the association between the ectodermal dysplasia and the medial dysraphia of the face.
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