Successful Management of Cleft Lip and Palate Malformation without Pre-Surgical Infant Orthopedics.

OBJECTIVE: To investigate the effect of lip closure on reduction of cleft palates when no pre-surgical infant orthopedics (PSIO) are used. STUDY DESIGN: Retrospective patient chart-review in our department for Cranio-Maxillofacial Surgery at the University Medical Centre Freiburg, Germany. 19 patients at the age of 5.9 ± 2.1 months with surgical treatment of uni- (UCLP), or bilateral cleft lip and palate (BCLP) without any use of PSIO were included. RESULTS: Early soft tissue correction of the lip leads to an effective reduction of the maxillary arch without any use of PSIO. The presented conventional and digital measurements appeared to be reliable. A successful reduction of the cleft width (UCLP = 3.88 ± 2.42mm, BCLP = 7.33 ± 5.00mm), the width of the alveolar arch (1.91 ± 1.36mm) and the sagittal depth of the alveolar arch (3.07 ± 2.71 mm) could be achieved with the presented workflow. CONCLUSIONS: Cleft reduction was obtainable without PSIO when lip closure after Tennison-Randall was performed.

The role of tongue-tie in breastfeeding problems-A prospective observational study.

AIM: We evaluated what determined breastfeeding problems in a non-selected mother-infant cohort, with special reference to tongue-tie and improvements in breastfeeding following frenulotomy. METHODS: This 2014-2015 prospective, observational study was carried out in a tertiary level maternity unit affiliated to the University of Freiburg, Germany, using a breastfeeding questionnaire, standardised breastfeeding scores and the Assessment Tool For Lingual Frenulum Function (ATLFF). The standard intervention was breastfeeding support, a frenulotomy for tongue-tie was performed if necessary. All cases of breastfeeding problems and, or tongue-tie, were followed up by telephone 2.5 weeks after birth. RESULTS: We enrolled 776 newborn-mother dyads: 345 had breastfeeding problems, 116 had a tongue-tie and 30 underwent a frenulotomy. In the multivariate analysis, severe breastfeeding problems were more frequent in newborn infants with tongue-tie, with an odds ratio (OR) of 2.6 (P= 0.014). Other risk factors were: no breastfeeding experience (OR 4.4, P = 0.001), low birth weight (OR 2.9, P = 0.001), prematurity (OR 3.6, P = 0.000) and Caesarean section (OR 1.6, P = 0.023). There was a significant reduction in breastfeeding problems after frenulotomy (P = 0.01). CONCLUSION: Tongue-tie had a significant impact on breastfeeding and so did low birth weights and prematurity. Frenulotomy proved helpful when breastfeeding problems were reported.

Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type.

OBJECTIVES/HYPOTHESIS: The prevalence of tympanostomy tube surgery (TTS) in patients with a cleft deformity was investigated, in relation to cleft width and cleft type. STUDY DESIGN: Retrospective review of medical health records. METHODS: Retrospective review of medical health records. Seventy-eight patients with non-syndromic cleft deformity of the palate and/or alveolus and lip between 2003 and 2017 were investigated. All available medical documents were analyzed. The study group was divided into subgroups: 1) patients with isolated cleft palate (CP) and patients with a cleft palate with cleft lip and alveolus (CLP). 2) According to Veau's classification (I-IV), further subgroups were defined. Cleft width was measured using plaster cast models. RESULTS: TTS was performed in 55% of the patients (n = 43). Considering Veau's classification, TTS was conducted as follows: Veau I 65.2% (n = 15/23), Veau II 55.0% (n = 11/20), Veau III 47.6% (n = 10/21), and Veau IV 50.0% (n = 7/14). Cleft classifications, maxillary arch width, and absolute/relative cleft width had no statistical impact on TTS occurrence. Although no significant correlation could be found, patients in our study group with CP (Veau I and II) underwent TTS more often (60.5%, n = 26/43) than patients with CPL (Veau III and IV; 48.6%, n = 17/35) during a three-year follow-up. CONCLUSION: None of the cleft characteristics examined had a significant impact on the proportion of patients who received TTS. Nevertheless, patients with lower Veau classification and CP received tympanostomy tubes more often. Therefore, otolaryngologists and pediatricians treating children with cleft palate should maintain a high level of suspicion for chronic middle ear effusion, even in patients with small clefts. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2764-E2769, 2021.

Current concepts in cleft care: A multicenter analysis.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.

Biomechanical testing of different osteosynthesis systems for segmental resection of the mandible.

PURPOSE: This investigation assessed the mechanical behavior of 3 different locking and nonlocking reconstruction systems-Unilock 2.4, Reconstruction 2.4, and Reconstruction 2.7-with regard to plate and screw fracture. MATERIALS AND METHODS: Five different plate/screw configurations (Unilock 2.4-locking screws, Unilock 2.4 -conventional screws, Reconstruction 2.4-conventional screws, Reconstruction 2.7-conventional screws, and Unilock 2.4-locking screws with a 1-mm gap; Synthes, Umkirch, Germany) were tested on synthetic mandibles. All mandibles were resected on the left side between the canine and third molar, reconstructed, and loaded cyclically between 30 and 300 N up to 250,000 cycles or until screw or plate failure occurred. RESULTS: No screw fractures were observed. All plates fractured close to the distal fragment. The Unilock plates fixed with locking screws withstood significantly more cycles until failure than the Reconstruction plates 2.4 fixed with conventional MF-Cortex screws. No significant differences were found in the other groups. Only 2 of the 34 plates tested, both of the Reconstruction 2.7 system, reached the runout limit. CONCLUSIONS: Unilock plates fixed with locking screws have a higher long-term stability than the Reconstruction 2.4 system. A 1-mm gap between the plate and mandible does not lead to early screw failure in the Unilock 2.4 system with locking screws. The Reconstruction 2.7 system seems superior if well contoured, because 2 of those plates reached the runout limit; however, this system is not as easy to handle as the 2.4 systems, and good contouring is difficult to achieve. Therefore, we consider the Unilock 2.4 system with locking screws the best choice.

Salivary gland lipomas: ultrasonographic and magnetic resonance imaging.

To facilitate a diagnosis of a lipoma, specific imaging is needed such as ultrasound or magnetic resonance imaging (MRI). Two male patients exhibiting a soft tissue tumor in the salivary gland area were examined using sonography and MRI. Final diagnosis was identified by excision biopsy. Ultrasound showed a hypoechoic, feathered, mostly ovoid structure. Color Doppler sonography does not detect any signals besides in cases of angiolipoma. This is accompanied by vessels and does not show the typical feathered structure. With MRI, it is possible to confirm the diagnosis by visualization of fat-equivalent intensity values. Diagnosing soft tissue swelling in the salivary gland, clinical examination and an ultrasound or MRI scan are recommended.