RESUMO
Botulinum toxin type-A (BTX-A) injections have emerged as a promising treatment for bruxism and temporomandibular joint (TMJ) disorders. However, there is a need for further exploration of optimal dosage, injection techniques, and intervals to maximize treatment effectiveness. Complications, such as velopharyngeal insufficiency, can occur after BTX-A injections, emphasizing the importance of precautionary measures. The utilization of ultrasound guidance and electromyography assistance can aid in precise injections and minimize the risk of complications. In addition, patients should receive appropriate medication and adhere to post-treatment instructions to alleviate symptoms. Follow-up procedures are essential to monitor potential complications, and in some cases, professional mental health care may be required. Further research is warranted to establish the safety and efficacy of BTX-A injections for the treatment of bruxism and TMJ disorders. This case study presents the development velopharyngeal insufficiency in a patient with chronic bruxism 3 days after receiving a BTX-A injection.
RESUMO
BACKGROUND: This study aimed to classify fingertip defects according to dimensions and composite content, and present algorithmic reconstruction results with free lateral great-toe flaps. METHODS: A total of 33 patients who underwent reconstruction for full-thickness defects of fingertips with free lateral great-toe flaps were retrospectively reviewed. Patients were divided into four groups by the algorithm according to the dimension and content of defects. Functional disabilities of the upper extremities, limitations of donor feet, finger cosmetics, sensory recovery, and pinch power were evaluated using the disabilities of the arm, shoulder and hand, foot function index, 5-point Likert satisfaction scales, Semmes-Weinstein monofilament and static 2-point discrimination tests, and pulp pinch-strength test, respectively. RESULTS: The standardized distribution of patients according to dimensions and content of defects was achieved. When the composite content of defects increase such as group 4, complex surgical skills are required, duration of surgery is extended, return to work is delayed, and donor-site complications are increased. Functional limitations of the hands improved normally after reconstruction (p < 0.00). Sensory recovery of flaps was normal and test scores were strongly correlated (p = 0.78). All patients and observers were satisfied with finger's cosmetics. CONCLUSION: Our classification and reconstruction algorithm is simple and easy to apply for all fingertip defects without complicated reference points, and it provides information about the surgical and post-surgical periods. When the dimension and composite deformities of the defect increase through groups 1-4, more complex reconstruction, increased donor-site complications, prolonged duration of surgery, and delayed return to work are observed.
Assuntos
Dedos , Hallux , Procedimentos de Cirurgia Plástica , Humanos , Traumatismos dos Dedos/cirurgia , Traumatismos dos Dedos/complicações , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento , Dedos/cirurgiaRESUMO
BACKGROUND: The anterolateral thigh (ALT) perforator flap is well-described and versatile option for reconstruction of soft tissue defects around foot and ankle. This retrospective review was performed for reconstruction of soft tissue defects around foot with ALT perforator flaps in patients with normal and overweight body mass index (BMI). METHODS: Between January 2016 and November 2020, ALT flaps were used in 30 patients for foot defects. RESULTS: Etiologic factors were trauma (18 patients), diabetic foot ulcer (6 patients), tumor (3 patients), infection (2 patients) and burn contracture (1 patient). Mean body mass index (BMI) value was 24.9 ± 4.1 (17-30). Mean flap dimension was 145 ± 86 (40-420) cm2. Recipient vessels were anterior tibial artery in 17 patients (56%), posterior tibial artery in 12 patients (40%), reversed flow dorsalis pedis artery in 1 patient (3.3%). In 24 patients (80%), 2 vein anastomoses were done. Debulking were applied in two patients (6.6%). Donor area was grafted in four patients (13.3%). Mean flap score was 1.25 ± 0.5. Mean flap thickness was 10 ± 2 (7-14) mm. Visual Analogue Scale (VAS) score was 7.75 ± 1.04 (6-10). The patients were followed up for a mean of 14 ± 11 (1-30) months. CONCLUSION: We think that ALT flap is still reliable and precious option because it provides ideal soft tissue reconstruction by means of recontouring of foot in nonobese patients.
RESUMO
Heparin-induced thrombocytopenia (HIT) is an underestimated complication of heparin treatment. Flap loss and related morbidity (even mortality) are caused by occlusion of the capillary vessels by a highly immunogenic complex formed by adherence of antiheparin antibodies to platelet factor 4. Early suspicion and effective treatment of HIT developing in two free flaps are described. We report on the management of two patients with HIT. Both patients were treated successfully by early suspicion and hematology consultation. Heparin products were discontinued; the patients were switched to a nonheparin anticoagulant. We emphasize the importance of early diagnosis, hematologist assessment, and a change to a nonheparin anticoagulant to prevent flap failure and possibly the catastrophic consequences of such failure.
RESUMO
OBJECTIVE: The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. METHODS: Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3âcm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. RESULTS: Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. CONCLUSIONS: Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity.
Assuntos
Sobrevivência de Enxerto , Retalhos Cirúrgicos , Animais , Masculino , Necrose , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: Nicolau syndrome (NS) is a rare complication that develops after the administration of intramuscular diclofenac sodium. The etiology and surgical treatments of 11 patients with NS were evaluated and studies in the literature were examined. The aim of this study was to compose a basic algorithm for surgical approaches to treat NS. MATERIALS AND METHODS: Eleven patients were evaluated for NS between December 2013 and January 2018. Two patients did not accept treatment, and nine patients underwent surgical debridement of necrotic tissues. The tissue defects of five patients were closed with a fasciocutaneous flap and, in four patients, the defects were repaired primarily. RESULTS: No complications, such as wound infection, wound dehiscence, seroma, or flap necrosis, were encountered. Of the seven patients who received concurrent antibiotic therapy, no patient had any problems at their follow-up (2-30 months). The results were satisfactory from an aesthetic and functional point of view. CONCLUSION: NS was more frequent in women with a high body mass index and high fat in gluteal regions. We considered that any kind of medication could lead to NS. Different methods are discussed for treatment.
RESUMO
Fibrous dysplasia (FD) is a developmental bone disorder caused by the hamartamatous proliferation of bone-forming cells. A 29-year-old male patient with diagnosis of FD was admitted to our clinic with the symptoms of severe craniomaxillofacial involvement of FD beginning from last year. Neurological examination revealed diplopia, horizontal nystagmus, conductive hearing loss, and partial vision loss. In his medical history, it was reported that he had undergone intramedullary nailing operation in his left femur due to a pathological fracture approximately 8 years ago in the orthopedics clinic of our institution. The patient underwent 3 consecutive surgeries by our plastic and neurosurgical team. The patient was followed-up in the neuro-intensive care unit between the surgical sessions and 1 week after the last operation. Afterwards, he was transferred to the neurosurgical department. No postoperative complication was detected. The preoperative signs were recovered. During his 6th month follow-up control-visit, all his preoperative symptoms were improved. In addition, the patient was satisfied with his postoperative cosmetic improvement. In conclusion, virtual surgical planning and intraoperative surgical navigation systems can make the challenging cases possible to operate with increasing the safety margin of the surgical procedures for polyostotic FD.
Assuntos
Criocirurgia , Displasia Fibrosa Poliostótica/cirurgia , Adulto , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Tomografia Computadorizada por Raios XRESUMO
COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.
Assuntos
Algoritmos , COVID-19/epidemiologia , Pé Diabético/terapia , Antibacterianos/uso terapêutico , Desbridamento , Humanos , Pandemias , Exame Físico , TelemedicinaRESUMO
To present the use of Limberg flap in the central midface reconstruction as an useful flap in elderly patients. A retrospective review of a total of 13 cases who underwent Limberg flap procedure to reconstruct various sizes of midfacial defects. Etiology, size, location, surgical procedures, outcomes, and complications, final evaluation according to the tumor-free survival and patient satisfaction in terms of aesthetic appearance were analyzed, the latter was evaluated by visual analog scoring system. The mean follow-up period was 11.53 months (2-22 months). The mean age of cases was 68 years (between 49 and 81 years). Average defect size was 7.76 cm2 (between 2.25 and 25 cm2 ). All operations were performed under local infiltration anesthesia. All patients were discharged on the same day of the operation. All the flaps survived with uneventful wound healing according to the patient satisfaction scores that were reliable and high. No any early or late recurrence was detected. Limberg flap is a safe and rapid option that could be applied in small- and medium-sized cutaneous defects in the central midface reconstruction in elderly patients.
Assuntos
Seio Pilonidal , Procedimentos de Cirurgia Plástica , Idoso , Face , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The prevalence of secretory otitis media is very high among the nonoperated cleft palate patients. METHODS: Ninety-one cleft palate operations were performed on late presented cases in Sudan, Africa. The surgeries were performed according to the Veau-Wardill-Kilner push-back technique. A laptop connected pen-type endoscopic camera was used to evaluate the tympanic membrane and address middle ear disease in all patients simultaneously. The procedure was performed after removing wax from the external auditory canal. A small incision was made with a myringotomy knife through the layers of the tympanic membrane if any sign of fluid collection was observed, after which the middle ear effusion was evacuated and the ventilation tube was inserted. RESULTS: This procedure was undertaken in 182 ears; 41 ears (22.5%) were healthy, 19 ears (10.5%) had chronic perforations, 122 ears (67%) underwent myringotomy procedures, and 54 (44.2%) were treated by inserting a ventilation tube. Despite the challenging work environment, standard monitoring facilities were available and all operations were completed with no early complications. CONCLUSION: The pen-type camera instead of an operating microscope was a tremendous contribution, as it was easy to handle and contributed to the good outcomes. The use of this technique is strongly recommended in surgical camps. LEVEL OF EVIDENCE: III.
Assuntos
Fissura Palatina , Endoscópios , Ventilação da Orelha Média , Otite Média com Derrame , Adulto , Fatores Etários , Criança , Fissura Palatina/complicações , Fissura Palatina/cirurgia , Feminino , Humanos , Lactente , Masculino , Ventilação da Orelha Média/instrumentação , Ventilação da Orelha Média/métodos , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/etiologia , Otite Média com Derrame/fisiopatologia , Otite Média com Derrame/cirurgia , Sudão , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Membrana Timpânica/diagnóstico por imagem , Membrana Timpânica/cirurgiaRESUMO
BACKGROUND: Reconstruction of small joints of fingers is still challenging in hand surgery. Implant arthroplasty and arthrodesis have some limitations in the reconstruction of small finger joints. Free vascularized PIP joint transfer from second toe to finger is a promising autogenous reconstructive alternative. METHODS: In this prospective study, 7 cases of free vascularized PIP joint transfer were analyzed. The measurements for active and passive range of motion (ROM), grip, and pinch strength has been done preoperatively and 1-year postoperatively. The functional change in daily life quality and work-related activities was evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Mean follow-up period was 20.3 months (12-25). Preoperative mean active and passive ROM values were 3.6° (0-14°) and 11.9° (0-29°), respectively. Postoperative 1-year measurements revealed a mean active ROM of 24.1° and a mean passive ROM of 31.6°. Mean grip and pinch strength increased from 52.1 to 58.6 lbs and from 5.1 to 5.9 lbs, respectively. Mean preoperative and postoperative DASH-scores were 41.3 and 30.3. CONCLUSION: The improvement in ROM, increasing grip strength, and declining DASH scores in our study support that free vascularized joint transfer improves patients' daily life quality and work-related activities via providing a functional joint if performed with appropriate indications, careful planning, and meticulous surgical execution. Free vascularized joint transfer provides an autogenous, painless, mobile, and stable joint. It also has the advantages of composite tissue reconstruction and lacks the disadvantages of arthrodesis and synthetic joint implants.
Assuntos
Tendão do Calcâneo/cirurgia , Tomografia Computadorizada Multidetectores/métodos , Retalho Miocutâneo/cirurgia , Retalho Perfurante/transplante , Lesões dos Tecidos Moles/cirurgia , Cicatrização/fisiologia , Adulto , Feminino , Seguimentos , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Múltiplas/cirurgia , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/cirurgia , Recidiva , Reoperação/métodos , Medição de Risco , Lesões dos Tecidos Moles/diagnóstico por imagem , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/cirurgia , Resultado do TratamentoRESUMO
We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process. Between January 2009 and January 2017, 33 wound edge-based propeller perforator flaps were used to cover pressure sores at various locations in 28 patients. In four cases more than one flap was used on the same patient. The patients comprised 18 males and 10 females with a mean age of 41·25 (range, 16-70) years. All patients underwent follow-up for 0-12 months. The mean follow-up duration was 5·03 months. Venous congestion was observed in three flaps that were rotated by 180° (9·1%). However, there was a significant difference between flaps rotated by 90° and 180° according to the complication rate (P = 0·034). Out of 33 flaps, 29 flaps healed uneventfully. Patients were able to sit and lie on their flaps three weeks after surgery. In our study, we were able to obtain satisfying final results using these novel flaps.
Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica/métodos , Úlcera por Pressão/cirurgia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/etiologia , Úlcera por Pressão/patologia , Resultado do Tratamento , Cicatrização , Adulto JovemRESUMO
BACKGROUND: Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger's horizontal septum and inferior pedicle techniques. METHODS: This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger's horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm. RESULTS: The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g). CONCLUSIONS: This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Mamilos/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Mama/cirurgia , Estudos de Coortes , Estética , Feminino , Seguimentos , Humanos , Hipertrofia/diagnóstico , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Cicatrização/fisiologia , Adulto JovemRESUMO
BACKGROUND: Electrical burns are the third most common cause of burn injuries, after scald and flame burns. In spite of decreasing mortality rates as advancements are made in treatment modalities and medical equipment, significant complications and socioeconomic consequences still accompany electrical burns. Analyzed in the present study were data from patients hospitalized for electrical burns between 2008 and 2012 in the Samsun Training and Research Hospital, the only burn care center in the Black Sea region of Turkey. METHODS: Data from 94 patients (84 males, 10 females) hospitalized for electrical burns between 2008 and 2012 were retrospectively evaluated. Patient age, gender, occupation, presence of coexisting trauma, burn degree, burned percentage of total body surface area (TBSA), voltage of the electric current (low or high), medical cost (per day and total), and infection rates were analyzed. RESULTS: Mean patient age was 26.4±13.2 years. Ten patients were female (10.6%) and 84 were male (89.4%). High-voltage burns were sustained by 47 patients (50%) and low-voltage burns by 42 (44.7%); the remaining 5 were flash burns. Mean burned TBSA was 21.8±19.8% in high-voltage injuries and 11.9±6.9% in low-voltage injuries. Seven patients had accompanying soft tissue lacerations, major bone fractures, or epidural hematomas. Findings of infection were encountered in 31 patients (32.9%), and appropriate treatments were initiated according to culture results. Mean duration of hospitalization was 21.3±19.8 days in patients with high-voltage burns and 8.6±6.2 days in patients with low-voltage burns. Mean hospital stay was 2.5-fold longer, and total medical costs were 4-fold higher in patients with high-voltage burns. CONCLUSION: Young adult males who were injured in industrial accidents constituted the majority of high-voltage burn patients. Incidence of these injuries may be reduced by improvements in training regarding the safe use of electrical devices, and correct installation and safe maintenance of power grids, as well as by a review of occupational safety regulations.
Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras por Corrente Elétrica/epidemiologia , Adolescente , Adulto , Idoso , Superfície Corporal , Queimaduras por Corrente Elétrica/complicações , Queimaduras por Corrente Elétrica/patologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Saúde Ocupacional , Estudos Retrospectivos , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The aim of the present study was to evaluate the viability and proliferative capacity of adipose-derived stem cells obtained by laser-assisted liposuction (LAL). METHODS: Fat tissue was obtained from 7 male patients treated surgically for gynecomastia. On one side, harvesting was made before LAL, while it was implemented after LAL on the contralateral side. Viability, cell surface antigens, pluripotency, and apoptosis were assessed and compared in these samples. RESULTS: Cells harvested before and after LAL did not exhibit any significant difference in terms of surface cell markers. Number of viable stem cells was lower initially after exposure to laser, while this difference was reversed at the end of 72âhours. Genetic indicators of cellular differentiation were similar in both groups. Apoptosis indicators were increased remarkably after laser exposure in the first 24âhours, but this increase was absent 72âhours after LAL procedure. CONCLUSION: The authors' results have promising clinical relevance since mesenchymal stem cells harvested during LAL have maintained appropriate cellular features to be used for autologous fat transfer and fat grafting.
Assuntos
Adipócitos/citologia , Terapia a Laser/métodos , Lipectomia/métodos , Sucção/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Humanos , Masculino , Células-Tronco Mesenquimais/citologia , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to generate skin tissue using adipose tissue-derived mesenchymal stem cells. METHODS: Thirty Wistar albino rats were used. A 2-cm-diameter full-thickness skin defect on the back of each rat was formed. A secondary wound healing model was constituted in group 1, fibrin matrix only was applied in group 2, a keratinocyte-coated fibrin matrix was applied in group 3, an adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied in group 4, and a keratinocyte-coated and adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied to the defects in group 5. RESULTS: A similar form of wound healing, with contraction from the edges and ulceration at the center, was observed in groups 1, 2, and 3. The wound contraction was reduced in group 4, and the epidermis was creeping from the surrounding tissue but with some ulcerations in the central part of the wounds. In group 5, the defect area was almost totally epithelialized, with minimal wound contraction. By microscopic analysis, significant increases in the collagen volume ratios and vascular volume ratios were determined in groups 4 and 5. From the fluorescent micrographs, fibroblastic differentiation and extracellular matrix synthesis, endothelial differentiation of stem cells, and neoangiogenesis and epithelium derived from marked keratinocytes were observed in group 5. CONCLUSION: Formation of the adipose tissue-derived mesenchymal stem cell-seeded and keratinocyte-coated autologous fibrin scaffold leads to significant skin replacement.
Assuntos
Tecido Adiposo/citologia , Transplante de Células-Tronco Mesenquimais/métodos , Regeneração/fisiologia , Pele Artificial , Pele/lesões , Adipócitos/citologia , Animais , Células Cultivadas , Modelos Animais de Doenças , Fibroblastos/citologia , Queratinócitos/citologia , Queratinócitos/transplante , Ratos , Ratos Wistar , Sensibilidade e Especificidade , Pele/crescimento & desenvolvimento , Engenharia Tecidual/métodos , Alicerces Teciduais , Transplante AutólogoRESUMO
BACKGROUND: In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. MATERIALS AND METHODS: A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. RESULTS: The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. DISCUSSION: The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.